Diagnostic utility of major basic protein, eotaxin-3, and leukotriene enzyme staining in eosinophilic esophagitis.

Objectives: Features of eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) overlap. We aimed to determine whether staining for tissue biomarkers would differentiate EoE from GERD, suggesting utility for diagnosis of EoE.

Methods: In this case-control study, EoE patients defined by consensus guidelines were compared to GERD patients with eosinophils on esophageal biopsy.

Focal endoscopic mucosal resection before radiofrequency ablation is equally effective and safe compared with radiofrequency ablation alone for the eradication of Barrett's esophagus with advanced neoplasia.

Background: EMR is commonly performed before radiofrequency ablation (RFA) for nodular dysplastic Barrett's esophagus (BE).

Objective: To determine the efficacy and safety of EMR before RFA for nodular BE with advanced neoplasia (high-grade dysplasia [HGD] or intramucosal carcinoma [IMC]).

Design: Retrospective study.

Diagnosis and management of eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition characterized by esophageal dysfunction and eosinophilic infiltrate in the esophageal epithelium in the absence of other potential causes of eosinophilia. EoE is increasing in incidence and prevalence, and is a major cause of gastrointestinal morbidity among children and adults. EoE is thought to be immune mediated, with food or environmental antigens stimulating a T-helper (Th)-2 inflammatory response.

The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis.

Background & Aims: Endoscopic findings such as esophageal rings, strictures, narrow-caliber esophagus, linear furrows, white plaques, and pallor or decreased vasculature might indicate the presence of eosinophilic esophagitis (EoE). We aimed to determine the prevalence and diagnostic utility of endoscopic features of EoE.

Methods: We conducted a systematic review and meta-analysis.

Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis.

We performed a randomized trial to compare nebulized and viscous topical corticosteroid treatments for eosinophilic esophagitis (EoE). Subjects with incident EoE (n = 25) received budesonide 1 mg twice daily, either nebulized and then swallowed (NEB) or as an oral viscous slurry (OVB), for 8 weeks. Baseline eosinophil counts for the NEB and OVB groups were 101 and 83 (P = .

Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures.

Background: Gastroenterology specialty societies have advocated that providers routinely assess their performance on colonoscopy quality measures. Such routine measurement has been hampered by the costs and time required to manually review colonoscopy and pathology reports. Natural language processing (NLP) is a field of computer science in which programs are trained to extract relevant information from text reports in an automated fashion.

Emergency care of esophageal foreign body impactions: timing, treatment modalities, and resource utilization.

Esophageal foreign body impaction (EFBI) often requires urgent evaluation and treatment, but characteristics of emergency department (ED) care such as timing of presentation and therapeutic procedures and costs of care are unknown. We aimed to study health-care utilization for patients with EFBI presenting to the ED. Cases of EFBI from 2002 to 2009 were identified by querying three different databases from the University of North Carolina Hospitals for all records with ICD-9 CM code 935.

Eosinophilic esophagitis: diagnostic tests and criteria.

Purpose Of Review: To present the clinical, endoscopic, and histologic features of eosinophilic esophagitis (EoE), review the current diagnostic guidelines for EoE, and present an approach for diagnosis of EoE. It will also highlight selected techniques that are under development that may be useful in the future for diagnosis of EoE.

Recent Findings: Recently updated guidelines emphasize that EoE is a clinicopathologic condition.

Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video).

Background: Endoscopic screening for esophageal neoplasia can identify patients eligible for early intervention for precancerous lesions. Unsedated transnasal esophagoscopy may provide an efficient and accurate endoscopic assessment with fewer risks and less cost, compared with conventional upper endoscopy.

Objective: To assess the feasibility, safety, acceptability, and yield of unsedated transnasal esophagoscopy in a primary care population.

Eosinophilic infiltration of the esophagus following endoscopic ablation of Barrett's neoplasia.

To assess the incidence of esophageal intra-epithelial eosinophilic infiltration following endoscopic ablation of Barrett's esophagus (BE), a retrospective study of consecutive cases of endoscopic ablation of BE with dysplasia or cancer using radiofrequency ablation (RFA) and spray cryotherapy at two centers in the United States was performed. Post-ablation eosinophilia was defined as ≥ 5 eosinophils per high power field during post-treatment surveillance. Twenty of 122 patients (16%) undergoing ablation developed esophageal eosinophilia after ablation, including 8/77 (10%) treated with RFA and 12/44 (27%) treated with cryotherapy.

Epidemiology and management of oesophageal coin impaction in children.

Objective: The epidemiology of oesophageal coin impaction in children is poorly understood. We aimed to assess characteristics of patients with coin impaction and identify predictors of type of coin impacted and management strategies.

Methods: Cases of coin impaction from 2002 to 2009 were identified by querying a tertiary care centre's billing, clinical, and endoscopy databases for the International Classification of Diseases, 9th Revision code "935.

Prevalence of esophageal eosinophilia varies by climate zone in the United States.

Objectives: The epidemiology of eosinophilic esophagitis (EoE) is rapidly evolving, and differences in climate could impact the prevalence of EoE. We aimed to examine the association between esophageal eosinophilia and climate zones in the United States.

Methods: This was a cross-sectional study of esophageal biopsies from 2008 to 2010 in a large US pathology database.

Impact of nighttime and weekend liver transplants on graft and patient outcomes.

Safety concerns have been raised about nighttime and weekend patient care, but it is unknown whether these issues affect liver transplantation. We sought to identify the impact of nighttime and weekend liver transplants on graft and patient survival. We used the United Network for Organ Sharing database to review adult liver transplants from 1987 to 2010.

Physician practices for communicating with patients with cystic fibrosis about the use of noninvasive and invasive mechanical ventilation.

Background: Many patients with advanced cystic fibrosis (CF) lung disease receive intensive treatments such as noninvasive and invasive mechanical ventilation for respiratory failure after little or no communication with physicians.

Methods: Using surveys and follow-up interviews, physicians at two major CF care centers reported their practices for discussing intensive treatment preferences with patients with CF and about barriers and facilitators to communication.

Results: Surveys were completed by 30 (88%) and 26 (76%) of 34 eligible CF physicians who provide care for children (60%), adults (23%), or both (17%).

Influence of race and gender on the presentation of eosinophilic esophagitis.

Objectives: Eosinophilic esophagitis (EoE) is thought to be more common among males and Caucasians, but little is known about the disease presentation among patients with different genders or racial backgrounds. The objective of this study was to determine the clinical, endoscopic, and histologic characteristics of patients with EoE of different genders or racial backgrounds.

Methods: We conducted a retrospective study of the University of North Carolina EoE clinicopathologic database between January 2000 and December 2008.

Developing a natural language processing application for measuring the quality of colonoscopy procedures.

Objective: The quality of colonoscopy procedures for colorectal cancer screening is often inadequate and varies widely among physicians. Routine measurement of quality is limited by the costs of manual review of free-text patient charts. Our goal was to develop a natural language processing (NLP) application to measure colonoscopy quality.

Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis.

Background: The epidemiology of esophageal foreign-body impaction (EFBI) is poorly described, and the impact of the increasing prevalence of eosinophilic esophagitis (EoE) on this is unknown.

Objective: To assess the characteristics of patients with EFBI, to determine whether EFBI cases increased in proportion to EoE cases, and to identify predictors of EFBI.

Design: Retrospective study.

Markers of tyrosine kinase activity in eosinophilic esophagitis: a pilot study of the FIP1L1-PDGFRα fusion gene, pERK 1/2, and pSTAT5.

The pathogenesis of eosinophilic esophagitis (EoE) is incompletely understood. In certain eosinophilic diseases, activation of tyrosine kinase after fusion of the Fip1-like-1 and platelet-derived growth factor receptor-α genes (F-P fusion gene) mediates eosinophilia via downstream effectors such as extracellular-regulated kinase (ERK1/2) and signal transducers and activators of transcription (STAT5). This mechanism has not been examined in EoE.

Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database.

Background & Aims: Eosinophilic esophagitis (EoE) is of increasing prevalence and believed to result from allergic processes. Helicobacter pylori has been inversely associated with allergic diseases, but there is no known relationship between H pylori, EoE, and esophageal eosinophilia. We investigated the association between esophageal eosinophilia and H pylori infection.

Barriers to hospice for children as perceived by hospice organizations in North Carolina.

Despite improving organization of hospice for children with life-limiting illnesses, services may be underutilized. We asked representatives of all 76 existing North Carolina hospice organizations about barriers to serving children. Representatives of 61 agencies responded (80%).

Inverse relationship between moderate alcohol intake and rectal cancer: analysis of the North Carolina Colon Cancer Study.

Background: The relationship between alcohol intake and rectal cancer is uncertain.

Objective: We sought to evaluate whether alcohol consumption is associated with distal colorectal cancer and rectal cancer specifically.

Design: Data on alcohol intake were examined from the North Carolina Colon Cancer Study, a population-based case-control study of distal colorectal cancer.