Comparisons of Fluticasone to Budesonide in the Treatment of Eosinophilic Esophagitis.

Background: Topical steroids are first-line treatment agents for eosinophilic esophagitis; however, some studies have demonstrated modest efficacy in inducing histologic remission.

Aims: The aim of this study was to determine response to two topical steroids (fluticasone and budesonide), compare their efficacy, and examine patient characteristics which could predict non-response to topical steroids.

Methods: We performed a retrospective review of an established EoE registry.

Early Comparison of Inflammatory vs. Fibrostenotic Phenotype in Eosinophilic Esophagitis in a Multicenter Longitudinal Study.

Objectives: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that causes esophageal remodeling and stricture formation. We compared the clinical course of symptoms, endoscopic findings, histology, and changes in phenotype over time in EoE patients with inflammatory and fibrostenotic phenotypes.

Methods: Data were obtained from EoE patients from three medical centers and followed prospectively.

Effects of Race and Sex on Features of Eosinophilic Esophagitis.

Background & Aims: Clinical and endoscopic features of eosinophilic esophagitis (EoE) differ between children and adults and among racial backgrounds. We investigated whether there were any associations between race or sex and clinical presentation, endoscopic features, and histologic findings from patients with EoE of various racial backgrounds.

Methods: We performed a retrospective, multicenter, cross-sectional analysis of 793 patients with EoE (476 adults and 317 children; mean age, 26 years; range, 0.

Categorization of patients with reflux symptoms referred for pH and impedance testing while off therapy.

Background & Aims: Patients with suspected gastroesophageal reflux disease (GERD) often are treated empirically with proton pump inhibitors (PPIs). Patients whose symptoms are not reduced during the PPI trial are referred for further tests. We investigated whether patients referred for the evaluation of reflux symptoms had GERD.

The dose of omeprazole required to achieve adequate intraesophageal acid suppression in patients with gastroesophageal junction specialized intestinal metaplasia and Barrett's esophagus.

Background: The mainstay of medical therapy for Barrett's esophagus is normalization of esophageal acid exposure with proton pump inhibitors (PPIs). However, the optimal dose and whether once daily or twice daily is required for acid suppression is unknown.

Aim: The purpose of this study was to assess whether adequate intra-esophageal acid suppression could be achieved with once daily versus twice daily omeprazole in patients with gastroesophageal specialized intestinal metaplasia (GEJSIM), short-segment (SSBE) and long-segment Barrett's esophagus (LSBE).

Inflammatory bowel disease prevalence by age, gender, race, and geographic location in the U.S. military health care population.

Background: There is limited data examining the prevalence of inflammatory bowel disease (IBD) in a diverse North American population.

Methods: Using International Classification of Diseases, Ninth Revision codes, patients with Crohn's disease (CD) and ulcerative colitis (UC) seen within the military health care system (Tricare) from October 1, 2008 to September 30, 2009 were identified. This database comprised all active duty military, retirees, and dependents.

Randomized controlled trial comparing aerosolized swallowed fluticasone to esomeprazole for esophageal eosinophilia.

Objectives: Patients with clinical symptoms of esophageal dysfunction and dense eosinophilic infiltration of the esophageal mucosa are suspected to have eosinophilic esophagitis (EoE). Topical steroids are often used as first-line therapy for EoE, although some patients respond clinically to proton pump inhibitors (PPIs). The purpose of this study was to compare the histological and clinical response of patients with esophageal eosinophilia treated with aerosolized swallowed fluticasone propionate vs.

Efficacy of cryospray ablation for the treatment of chronic radiation proctitis in a pilot study.

Aim: Radiation proctitis, a common condition associated with radiotherapy for the treatment of pelvic cancers, is characterized by difficult to manage rectal pain and bleeding. Cryotherapy is a novel technique, previously used in the treatment of vascular ectasias in the upper gastrointestinal tract. The aim of the present study was to determine the efficacy of cryospray application in the treatment of radiation proctitis.

Esophageal motor disorders in adults with eosinophilic esophagitis.

Background: An association between eosinophilic esophagitis (EoE) and esophageal motility disorders has been described in small studies.

Aims: The aim of this study was to describe the prevalence of esophageal motor disorders in a large cohort of adults with EoE and examine whether an association exists between esophageal dysmotility and dysphagia.

Methods: A retrospective review of esophageal manometry studies in adult EoE patients was performed.

CT colonography may improve colorectal cancer screening compliance.

Objective: While colonoscopy is currently the preferred test for colorectal cancer (CRC) screening, the invasive and time-consuming characteristics of the test are often cited as reasons for noncompliance with screening. CT colonography (CTC) is a less invasive screening method that is comparable to colonoscopy for the detection of advanced neoplasia. The aim of this project was to assess patient preferences between colonoscopy and CTC in an open access system.

Extracolonic findings on CT colonography increases yield of colorectal cancer screening.

Objective: The purpose of this study is to evaluate the impact of extracolonic findings when screening is undertaken by CT colonography (CTC).

Materials And Methods: We performed a retrospective cohort study of patients completing a screening CTC from August 2003 to June 2006 at Walter Reed Army Medical Center. Extracolonic findings were categorized using a CTC reporting and data system that classifies findings as highly significant, likely significant, and insignificant.

Chronic proton pump inhibitor therapy associated with increased development of fundic gland polyps.

Background: Fundic gland polyps (FGP) have been implicated with long-term proton pump inhibitor (PPI) use.

Aims: We attempted to investigate the impact of length and dosage of PPI therapy on the development of FGP.

Methods: A retrospective cohort study of all patients who had gastric polyps removed during elective upper endoscopy between March and September 2007 as part of a prior prospective study protocol was carried out.

Prevalence of eosinophilic esophagitis in an adult population undergoing upper endoscopy: a prospective study.

Background & Aims: Eosinophilic esophagitis (EoE) is characterized by eosinophilic infiltration of the esophagus. The purpose of this prospective study was to determine the prevalence and clinical predictors of EoE in patients undergoing elective upper endoscopy.

Methods: We enrolled 400 consecutive adults (median age, 50 years; range, 19-92 years) who underwent routine upper endoscopy from March to September 2007 at a tertiary care military hospital.

A randomized comparison of methylene blue-directed biopsy versus conventional four-quadrant biopsy for the detection of intestinal metaplasia and dysplasia in patients with long-segment Barrett's esophagus.

Objectives: Methylene blue (MB) selectively stains specialized intestinal metaplasia (SIM) and may assist in surveying a columnar-lined esophagus for Barrett's esophagus associated dysplasia.

Methods: This is a prospective, randomized crossover study comparing 4-quadrant random biopsies (4QB) versus MB-directed biopsies for the detection of SIM and dysplasia in 48 patients with long segment Barrett's esophagus (LSBE). Patients randomly underwent two endoscopies over a 4-wk time period with either 4QB or MB-directed biopsies as their first or second exam.

Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?

Objectives: Prospective evidence supporting lifestyle modifications, including avoidance of late evening meals, for gastroesophageal reflux disease (GERD) sufferers is lacking. The aim of this study was to determine the difference of supine esophageal acid exposure in patients consuming an early or late standard meal relative to bedtime.

Methods: This is a prospective, randomized unblinded crossover trial.

Normalization of intestinal metaplasia in the esophagus and esophagogastric junction: incidence and clinical data.

Background: Attention has focused on whether normalization, regression, and development of dysplasia and cancer in specialized intestinal metaplasia (SIM) differ among long-segment Barrett's esophagus (LSBE), short-segment BE (SSBE), and esophagogastric junction SIM (EGJSIM). We prospectively followed a cohort of SIM patients receiving long-term antisecretory medications to determine: (a) histologic normalization (no evidence of SIM on biopsy), (b) change in SIM length, (c) incidence of dysplasia and cancer, and (d) factors associated with normalization.

Methods: One hundred forty-eight patients with SIM were identified in our original cohort.

Wireless capsule endoscopy in a community gastroenterology practice.

Goals: This study was performed to evaluate the use of wireless capsule endoscopy in a community gastroenterology practice.

Background: Experience with wireless capsule endoscopy at referral centers has been reported, but little has been reported about community gastroenterologists' experience.

Study: A retrospective review of charts and wireless capsule endoscopies performed at a community hospital was performed.

Schatzki's rings do not protect against acid reflux and may decrease esophageal acid clearance.

Schatzki's rings (SR) are a common cause of intermittent solid food dysphagia, but their etiology is unclear. Many believe they are related to acid reflux, hypothesizing that the rings act as a protective barrier against further reflux. The purpose of this study was to determine whether dilation of SR affected the degree of acid reflux.