2,578 research outputs found
Eosinophilic esophagitis : latest insights from diagnosis to therapy
No full textEosinophilic esophagitis (EoE) represents a chronic, local immune-mediated esophageal disease, characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Other systemic and local causes of esophageal eosinophilia should be excluded. Clinical manifestations or pathologic data should not be interpreted in isolation. EoE was first described as a distinct disease entity in 1993. Most patients are diagnosed with underlying food allergies. The first diagnostic and therapeutic guidelines were published in 2007 with a first update in 2011. In 2017, new international guidelines were published based on the GRADE methodology. These guidelines provide, among many other topics, insights on the role of proton pump inhibitor-responsive esophageal eosinophilia. Over the last two decades, considerable progress was made by stakeholders regarding the understanding of EoE's pathogenesis, genetic background, natural history, allergy workup, standardization of assessment of disease activity, evaluation of minimally invasive diagnostic tools, and new therapeutic approaches. This brief review provides further insights into latest diagnostic and therapeutic advances
Mr Alain Elkann Author and Journalist Italian Republic
No full textVisit by Mr Alain Elkann Author and Journalist Italian Republi
Epidemiologie und sozio-ökonomische Aspekte der chronisch entzündlichen Darmerkrankungen in der Schweiz
No full textEpidemiology and socio-economic aspects of chronic inflammatory bowel diseases in Switzerland Abstract. Inflammatory bowel diseases (IBD) are comprised of Crohn's disease and ulcerative colitis. Both diseases are diagnosed with increasing frequency over the last few decades in industrialized countries. Current, population-based data from Switzerland show a prevalence of 0.4 % for IBD in Switzerland (one affected person in 250 inhabitants) with equal shares for Crohn's disease and ulcerative colitis (one affected person in 500 inhabitants each). The mortality rate of Swiss IBD patients is comparable with the one of patients without IBD. Roughly 80 % of patients with IBD suffer from co-morbidities. The most frequent co-morbidities concern cardiovascular diseases, followed by rheumatologic conditions, acid-related disorders, pain, and psychologic disorders. The yearly costs for the care of IBD patients are constantly increasing. The biggest proportion of the annual costs for IBD care is related to outpatient costs of which drug costs represent the major cost driver.Morbus Crohn und Colitis ulcerosa sind chronisch-entzündliche Darmerkrankungen (CED) welche in den letzten Jahrzehnten in industrialisierten Ländern zunehmend häufig diagnostiziert werden. Aktuelle, populationsbasierte Daten aus der Schweiz zeigen eine Prävalenz von 0.4 % (1 Person auf 250 Einwohner) mit gleicher Häufigkeit für Morbus Crohn und Colitis ulcerosa (Prävalenz von je 1 Person auf 500 Einwohner). Die Mortalitätsrate von Schweizer Patienten mit chronisch entzündlichen Darmerkrankungen entspricht derjenigen der Population ohne chronisch entzündliche Darmerkrankungen. Rund 80 % der Patienten mit chronisch entzündlichen Darmerkrankungen leiden an Komorbiditäten. Am häufigsten werden kardiovaskuläre Erkrankungen beobachtet, gefolgt von rheumatologischen Affektionen, peptischen Erkrankungen, Schmerzstörungen sowie psychologischen Erkrankungen. Die jährlichen Kosten für die Behandlung von Patienten mit chronisch entzündlichen Darmerkrankungen sind im Zunehmen begriffen wobei die Hauptlast auf die ambulanten Kosten fällt. Ein wichtiger Bestandteil der ambulanten Kosten sind die Medikamente
Eosinophilic Esophagitis: Impact of Latest Insights Into Pathophysiology on Therapeutic Strategies.
No full textEosinophilic esophagitis (EoE) has been defined as a 'chronic, immune/antigen-mediated, esophageal disease, characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation'. A peak value of ≥15 eosinophils/high power field has been defined as histologic diagnostic cutoff. Other conditions associated with esophageal eosinophilia, such as gastro-esophageal reflux disease, PPI-responsive esophageal eosinophilia or Crohn's disease, need to be ruled out before EoE can be diagnosed. Males are affected more frequently than females and most of the patients have concomitant allergies. Currently, the EoE prevalence is about 1 of 2,000 inhabitants in Westernized countries. The first EoE patients were described only 2 decades ago. Despite this short period, considerable progress has been made regarding the understanding of the pathophysiology, natural history, assessment of disease activity and with respect to evaluating different therapeutic options. Untreated EoE can lead to esophageal remodeling with reduced compliance and stricture formation, which represents the main risk factor for food bolus impactions. The therapeutic options can be summarized with the 3 D's, which stand for drugs, diets and dilation. Of note, as of yet, there is no EoE-specific drug that has been approved by regulatory authorities. This is, among other reasons, related to the lack of validated outcome measurement instruments until recently. Swallowed topical steroids such as budesonide or fluticasone represent the standard of care for treating symptomatic pediatric and adult EoE patients with inflammatory activity. Several trials have already evaluated different biologic therapies, such as anti-interleukin-5 or anti-IgE. Further studies are on the way. As a non-pharmacologic alternative, different dietary regimens exist. Dilation can offer long-lasting symptomatic response in case of stricturing EoE but does not have any impact on the underlying inflammation. This review highlights the latest insights regarding pathophysiology and its impact regarding current and future therapeutic strategies
Pharmacologic Treatment of Eosinophilic Esophagitis: An Update
No full textEosinophilic esophagitis (EoE) is defined as a chronic, immune-medicated or antigen-mediated, esophageal disease, characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Food allergens are identified in most patients. Treatment strategies include elimination diets, drugs, and esophageal dilation. This article focuses on pharmacologic treatment. Currently, there is no pharmacologic treatment that has been approved by regulatory authorities. Established pharmacologic options to treat EoE include proton pump inhibitors and swallowed topical steroids. Several biologic therapies are currently under evaluation and some of them have shown promising results in improving biologic endpoints and patient-reported outcomes
Symptom-based patient-reported outcomes in adults with eosinophilic esophagitis: value for treatment monitoring and randomized controlled trial design.
No full textPURPOSE OF REVIEW
In adults with eosinophilic esophagitis (EoE), a chronic, inflammatory immune-mediated condition of the esophagus, both inflammation and fibrosis are likely associated with symptom generation. Therefore, assessing symptom-based patient-reported outcomes (PROs), defined by US Food and Drug Administration as 'any report of the status of a patient's health condition that comes directly from the patients, without interpretation of the patient's response by a clinician or anyone else', is important in the context of trials and observational studies of emerging therapies.
RECENT FINDINGS
For purposes of treatment monitoring, lack of symptoms does not predict the absence of biologic inflammation; hence, endoscopy with esophageal biopsies should be performed to check for residual inflammation. Lack of inflammation does not predict lack of symptoms, and the presence of subepithelial fibrosis cannot be excluded. No published instrument currently measures the frequency of dysphagia described all possible ways, strategies of living with this symptom and various pain types. In randomized controlled trials, in which symptom response was detected using validated PRO measures, only modest decreases in symptom scores were observed.
SUMMARY
Accessing full EoE symptom spectrum and optimizing PRO measures remains a challenge that should be tackled to reliably assess response to existing and emerging therapies
Patient-Reported Outcomes in Eosinophilic Esophagitis and Achalasia.
No full textOPINION STATEMENT
The activity of a particular esophageal disease, such as eosinophilic esophagitis (EoE) or achalasia, can be evaluated using clinician-reported outcome (ClinRO) measures assessing various endoscopic, histologic, functional, and laboratory findings, and patient-reported outcome (PRO) measures. The patient-reported outcome (PRO) measures are those that are designed to be self-reported by patients. Commonly used PRO instruments include those that assess symptom severity, health-related quality of life, "general" quality of life, or health status. Regulatory authorities increasingly rely on PRO measures to support labeling claims for drug development. Validated PRO measures for various esophageal diseases are needed in order to unify and standardize the way disease activity is assessed, define clinically meaningful endpoints for use in interventional and observational studies, compare the efficacy/effectiveness of various therapies, and optimize therapeutic algorithms for management of these diseases. This article reviews commonly used PRO instruments designed to assess symptom severity and quality of life in adult patients with EoE and achalasia
Can fecal calprotectin or lactoferrin identify postoperative recurrence in Crohn's disease?
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