Publications by authors named "Roger Garcia-Puig"
Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN).
J Pediatr Gastroenterol Nutr
August 2024
Article Synopsis
- Eosinophilic esophagitis (EoE) is a chronic condition affecting the esophagus, characterized by inflammation and eosinophil infiltration, necessitating updates to existing guidelines due to new medical knowledge.
- A group of pediatric gastroenterologists reviewed recent studies to create 52 statements and 44 recommendations related to EoE, focusing on diagnostics, treatment options, and diet changes from 2014 to 2022.
- The updated guidelines highlight the emergence of biologics for treatment, the potential role of steroids for esophageal strictures, and the importance of addressing quality of life and transitioning patients to adult care.
(1) Background: Previous studies showed an increased prevalence and incidence of coeliac disease (CD) over time. The objective is to ascertain whether the CD prevalence in Catalonia (a region of Southern Europe) among children aged 1-5 is as high as previously found in 2004-2009; (2) Methods: From 2013 to 2019, 3659 subjects aged 1-5 years were recruited following the previously used methodology. Factors with a potential impact on CD prevalence were investigated; (3) Results: In 2013-2019, 43/3659 subjects had positive serology, giving a standardised seroprevalence of 12.
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- This study evaluated how effective proton pump inhibitors (PPIs) are for treating children with eosinophilic esophagitis (EoE) in both the short- and long-term, using a step-down therapy approach.
- Results showed that after initial treatment, over half of the children achieved significant histological and clinical remission, with normal endoscopic appearances linked to better outcomes, while those with fibrostenotic phenotypes averaged poorer responses.
- Long-term follow-up indicated that most children could maintain remission with reduced medication, and those starting with complete histological remission had a higher chance of sustained success; adverse effects were minimal.
Introduction: The study of intraepithelial lymphocytes (IEL) by flow cytometry is a useful tool in the diagnosis of coeliac disease (CD). Previous data showed that an increase in %TCRγδ and decrease of %CD3 IEL constitute a typical CD cytometric pattern with a specificity of 100%. However, there are no data regarding whether there are differences in the %TCRγδ related to sex, age, titers of serology, and degree of histological lesion.
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- - Eosinophilic oesophagitis is a chronic immune-mediated disorder leading to oesophageal inflammation and dysfunction, particularly affecting males and those with allergies, and presenting different symptoms at varying ages.
- - Diagnosis involves identifying symptoms and finding at least 15 eosinophils per high power field in the oesophagus while excluding other causes, and without treatment, the disease can worsen in adults.
- - Treatment options include proton pump inhibitors, dietary changes, and corticosteroids, with an emphasis on maintaining therapy and using histological assessments to gauge treatment effectiveness; this document aims to guide the management of the condition based on updated guidelines.
Article Synopsis
- - The study evaluated how pediatric (PG) and adult gastroenterologists (AG) in Europe and the UAE diagnose and manage eosinophilic esophagitis (EoE), focusing on their adherence to clinical guidelines.
- - Results showed that PG are more likely to take biopsies and perform endoscopic follow-ups compared to AG; they also prefer elimination diets over steroids as a second-line therapy after proton-pump inhibitors fail.
- - The findings highlight significant practice differences between PG and AG, as well as regional variations across countries, suggesting that educational initiatives could help improve alignment with current guidelines.
Paromomycin is superior to metronidazole in Dientamoeba fragilis treatment.
Int J Parasitol Drugs Drug Resist
December 2019
Dientamoeba fragilis is a trichomonad parasite of the human intestine that is found worldwide. However, the biological cycle and transmission of this parasite have yet to be elucidated. Although its pathogenic capacity has been questioned, there is increasing evidence that clinical manifestations vary greatly.
View Article and Find Full Text PDFBackground & Aims: Determining whether patients with lymphocytic enteritis (LE) have coeliac disease is a challenge. We analysed the variables associated with a low-grade coeliac enteropathy diagnosis in patients with suspected coeliac disease but without villous atrophy, and developed a scoring system to identify them.
Methods: We collected data from 2010 through to 2016 on patients with lymphocytic enteritis and persistent symptoms compatible with the clinical spectrum of coeliac disease.
Article Synopsis
- The study assesses the diagnosis and treatment practices of pediatric gastroenterologists for eosinophilic esophagitis (EoE) in European children, highlighting a lack of real-world clinical data.
- Retrospective analysis of 410 patients revealed that common triggering allergens for EoE include milk and eggs, with many patients not responding to proton pump inhibitors (PPIs) before treatment.
- The findings indicate variations in treatment approaches, where a combination of dietary elimination and steroids was most common, and highlight challenges faced by physicians, such as patient refusal and limited endoscopy resources.
Background: 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.
Background & Aims: An increase in CD3+TCRγδ+ and a decrease in CD3- intraepithelial lymphocytes (IEL) is a characteristic flow cytometric pattern of celiac disease (CD) with atrophy. The aim was to evaluate the usefulness of both CD IEL cytometric pattern and anti-TG2 IgA subepithelial deposit analysis (CD IF pattern) for diagnosing lymphocytic enteritis due to CD.
Methods: Two-hundred and five patients (144 females) who underwent duodenal biopsy for clinical suspicion of CD and positive celiac genetics were prospectively included.
Background: It has been suggested that high titres of tTG are associated with elevated positive predictive values (PPV) for celiac disease. However, the PPV of a strongly positive tTG will depend on the celiac disease prevalence in the different risk groups of the disease
Aims: To assess the PPV of a strongly positive tTG for celiac disease. In addition, to calculate the post-test probability for celiac disease of a strongly positive tTG in a setting of routine clinical practice.
Among young children, pneumococcal nasopharyngeal colonization (NPC) rates of >90% have been described. The aim of our study was to assess the effect of amoxicillin exposure on the NPC. From Dec 2001 to Feb 2004, less than 5 years old children with respiratory symptoms and fever who were prescribed amoxicillin were eligible.
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