21 research outputs found
Development and validation of confocal endomicroscopy diagnostic criteria for low-grade dysplasia in Barrett’s esophagus
No full textBackground: Low-grade dysplasia (LGD) in Barrett’s esophagus (BE) is generally inconspicuous on conventional and magnified endoscopy. Probe-based confocal laser endomicroscopy (pCLE) provides insight into gastro-intestinal mucosa at cellular resolution. We aimed to identify endomicroscopic features and develop pCLE diagnostic criteria for BE-related LGD.Methods: This was a retrospective study on pCLE videos generated in two prospective studies. In Phase I, two investigators assessed 30 videos to identify LGD endomicroscopic features, which were then validated in an independent video set (n=25). Criteria with average accuracy >80% and interobserver agreement κ>0.4 were taken forward. In Phase II, 6 endoscopists evaluated the criteria in an independent video set (n=37). The area under receiver operating characteristic (AROC) curve was constructed to find the best cut-off. Sensitivity, specificity, interobserver and intraobserver agreement were calculated. Results: In Phase I 6 out of 8 criteria achieved the agreement and accuracy thresholds (i. dark non-round glands, ii. irregular gland shape, iii. lack of goblet cells, iv. sharp cut-off of darkness, v. variable cell size and vi. cellular stratification). The best cut-off for LGD diagnosis was 3 out of 6 positive criteria. In Phase II, the diagnostic criteria had a sensitivity and specificity for LGD of 81.69% and 6774.6%, respectively, with an AROC of 0.860888. The interobserver agreement was substantial (κ= 0.631654) and the mean intraobserver agreement was moderate (κ= 0.590). Conclusions: We have generated and validated pCLE criteria for LGD in BE. Using these criteria, pCLE diagnosis of LGD is reproducible and has substantial interobserver agreement
Second-Line Rescue Therapy With Moxifloxacin After Failure of Treatment to Eradicate Helicobacter pylori Infection
No full textPTH-121 Referral pathway and age influence the likelihood of biopsy to exclude eosinophilic oesophagitis in dysphagia
No full textIncreased production of the ether-lipid platelet-activating factor in intestinal epithelial cells infected by Salmonella enteritidis
No full textPTH-125 Variation in the investigation and diagnosis of eosinophilic oesophagitisin daily clinical practice
No full textReciprocal regulation of the nitric oxide synthase/arginase balance in mouse bone marrow‐derived macrophages by TH 1 and TH 2 cytokines
No full textL’échoendoscopie (EE) est-elle suffisante pour éliminer les tumeurs kystiques du pancréas à potentiel malin ? Suivi de 163 patients asymptomatiques
No full textStep-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study
No full textBACKGROUND:
Numerous dietary restrictions and endoscopies limit the implementation of empiric elimination diets in patients with eosinophilic esophagitis (EoE). Milk and wheat/gluten are the most common food triggers.
OBJECTIVE:
We sought to assess the effectiveness of a step-up dietary strategy for EoE.
METHODS:
We performed a prospective study conducted in 14 centers. Patients underwent a 6-week 2-food-group elimination diet (TFGED; milk and gluten-containing cereals). Remission was defined by symptom improvement and less than 15 eosinophils/high-power field. Nonresponders were gradually offered a 4-food-group elimination diet (FFGED; TFGED plus egg and legumes) and a 6-food-group elimination diet (SFGED; FFGED plus nuts and fish/seafood). In responders eliminated food groups were reintroduced individually, followed by endoscopy.
RESULTS:
One hundred thirty patients (25 pediatric patients) were enrolled, with 97 completing all phases of the study. A TFGED achieved EoE remission in 56 (43%) patients, with no differences between ages. Food triggers in TFGED responders were milk (52%), gluten-containing grains (16%), and both (28%). EoE induced only by milk was present in 18% and 33% of adults and children, respectively. Remission rates with FFGEDs and SFGEDs were 60% and 79%, with increasing food triggers, especially after an SFGED. Overall, 55 (91.6%) of 60 of the TFGED/FFGED responders had 1 or 2 food triggers. Compared with the initial SFGED, a step-up strategy reduced endoscopic procedures and diagnostic process time by 20%.
CONCLUSIONS:
A TFGED diet achieves EoE remission in 43% of children and adults. A step-up approach results in early identification of a majority of responders to an empiric diet with few food triggers, avoiding unnecessary dietary restrictions, saving endoscopies, and shortening the diagnostic process
The role of leishmania proteophosphoglycans in sand fly transmission and infection of the Mammalian host.
No full textLeishmania are transmitted by the bite of their sand fly vector and this has a significant influence on the virulence of the resulting infection. From our studies into the interaction between parasite, vector, and host we have uncovered an important missing ingredient during Leishmania transmission. Leishmania actively adapt their sand fly hosts into efficient vectors by secreting Promastigote Secretory Gel (PSG), a proteophosphoglycan (PPG)-rich, mucin-like gel which accumulates in sand fly gut and mouthparts. This has the effect of blocking the fly, such that during bloodfeeding both parasites and gel are co-transmitted in an act of regurgitation. We are discovering that this has further implications for the mammalian infection, again, in favor of the parasite. Experimentally, PSG exacerbates cutaneous and visceral leishmaniasis and can promote the chronicity of Leishmania infection, even in mouse strains normally capable of controlling leishmaniasis. The underlying mechanism of PSG's action is a major focus of our ongoing work. This review aims to synthesize what is known about the role and action of PSG and its constituent proteophosphoglycans, for parasite colonization of the sand fly, transmission, and mammalian infection. Lastly, we discuss potential exploitation of this important vector-transmitted product and future avenues of research
Su1997 - Generation and Validation of New Confocal Laser Endomicroscopy Criteria for the Diagnosis of Low-Grade Dysplasia in Barrett's Esophagus
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