https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

[Crohn's disease].

Epidemiology and Natural History of Inflammatory Bowel Diseases

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673612600269.pdf

Crohn's disease

Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical features. Since 2007, the number of EoE publications has doubled, providing new disease insight. Accordingly, a panel of 33 physicians with expertise in pediatric and adult allergy/immunology, gastroenterology, and pathology conducted a systematic review of the EoE literature (since September 2006) using electronic databases. Based on the literature review and expertise of the panel, information and recommendations were provided in each of the following areas of EoE: diagnostics, genetics, allergy testing, therapeutics, and disease complications. Because accumulating animal and human data have provided evidence that EoE appears to be an antigen-driven immunologic process that involves multiple pathogenic pathways, a new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The diagnostic guidelines continue to define EoE as an isolated chronic disorder of the esophagus diagnosed by the need of both clinical and pathologic features. Patients commonly have high rates of concurrent allergic diatheses, especially food sensitization, compared with the general population. Proved therapeutic options include chronic dietary elimination, topical corticosteroids, and esophageal dilation. Important additions since 2007 include genetic underpinnings that implicate EoE susceptibility caused by polymorphisms in the thymic stromal lymphopoietin protein gene and the description of a new potential disease phenotype, proton pump inhibitor-responsive esophageal eosinophila. Further advances and controversies regarding diagnostic methods, surrogate disease markers, allergy testing, and treatment approaches are discussed.

/pdf/eosinophilic-esophagitis-updated-consensus-recommendations-16knxh59cv.pdf

Eosinophilic esophagitis: Updated consensus recommendations for children and adults

BACKROUND & AIMS: Topical corticosteroids are effective in inducing clinical and histologic remission in patients with eosinophilic esophagitis (EoE). However, the best longterm management strategy for this chronic inflammatory disease has not been determined. METHODS: In a randomized, double-blind, placebo-controlled, 50-week trial, we evaluated in 28 patients the efficacy of twice-daily swallowed budesonide (0.25 mg each) to maintain quiescent EoE in remission. Pretreatment and posttreatment activity was assessed clinically, endoscopically, histologically, immunohistologically, and by endosonography. The primary end point was the therapy’s ability to maintain EoE in histologic remission. Secondary end points were efficacy in symptom control, prevention of tissue remodeling, and safety. RESULTS: In patients given low-dose budesonide, the load of esophageal eosinophils increased from 0.4 to 31.8 eosinophils/high-power field (P .017). In patients given placebo, the load increased from 0.7 to 65.0 eosinophils/ high-power field (P .0001); this increase was significantly greater than in patients given budesonide (P .024). The symptom scores developed in a similar manner in the 2 groups. Budesonide, but not placebo, reduced noneosinophilic markers of inflammation, epithelial cell apoptosis, and remodeling events. Compared with control individuals, patients had significantly thickened esophageal walls, based on endosonography (3.05 vs 2.18 mm; P .0001). Budesonide therapy was associated with a significant reduction in mucosal thickness (0.75‐ 0.45 mm; P .025), but epithelial thickness remained stable (261.22 vs 277.23 m; P .576). No serious adverse events occurred. CONCLUSIONS: Low-dose budesonide is more effective than placebo in maintaining EoE in histologic and clinical remission. Signs of esophageal remodeling showed a trend toward normalization. Long-term administration of topical corticosteroids was well tolerated without induction of epithelial atrophy.

ORIGINAL ARTICLES—ALIMENTARY TRACT Long-Term Budesonide Maintenance Treatment Is Partially Effective for Patients With Eosinophilic Esophagitis

Bei der eosinophilen Osophagitis (EoE, „eosinophilic esophagitis“) handelt es sich um eine in den 1990er-Jahren erstmals beschriebene Erkrankung mit steigender Inzidenz, die klinisch durch eine Dysfunktion des Osophagus und histologisch durch eine auffallige Eosinophileninfiltration gekennzeichnet ist. In diesem Artikel diskutieren wir neue Aspekte zur Pathogenese, Klinik, Diagnostik und Behandlung der EoE. Die EoE betrifft sowohl Kinder als auch Erwachsene und ist haufig mit atopischen Erkrankungen und IgE-Sensibilisierungen assoziiert. Als pathogenetisch wichtige Faktoren werden Barrierefunktionsstorungen und eine T-Helfer-2-Entzundung angesehen. Kurzlich wurden die PPI („proton pump inhibitors“, Protonenpumpenhemmer)-sensitive EoE und eine EoE-ahnliche Erkrankung neu beschrieben. Die Forschung der letzten Jahre hat zu einem besseren Verstandnis des Krankheitsspektrums, der Pathogenese einschlieslich genetischer Dispositionen beigetragen und damit auch die Grundlagen fur innovative Therapieansatze gegeben.

Aktuelle Konzepte zur eosinophilen Ösophagitis

P393 Occurrence of stricturing and penetrating complications is diminished in Crohn's disease patients treated by immunomodulatory and/or anti-TNF therapy within the first two years of disease duration when corrected for diagnostic delay

Mo1320 Therapeutic Escalation in Patients With Ulcerative Colitis: Systematic Analysis of the Prevalence and Risk Factors in the Swiss IBD Cohort

Sa1145 - Predictors for Early Versus Delayed Response to Budesonide Orodispersible Tablets in Eosinophilic Esophagitis Treatment: A Subgroup Analysis from the Pivotal Trial Eos-1

Alain M. Schoepfer

Papers

ORIGINAL ARTICLES—ALIMENTARY TRACT Long-Term Budesonide Maintenance Treatment Is Partially Effective for Patients With Eosinophilic Esophagitis

Aktuelle Konzepte zur eosinophilen Ösophagitis

P393 Occurrence of stricturing and penetrating complications is diminished in Crohn's disease patients treated by immunomodulatory and/or anti-TNF therapy within the first two years of disease duration when corrected for diagnostic delay

Mo1320 Therapeutic Escalation in Patients With Ulcerative Colitis: Systematic Analysis of the Prevalence and Risk Factors in the Swiss IBD Cohort

Sa1145 - Predictors for Early Versus Delayed Response to Budesonide Orodispersible Tablets in Eosinophilic Esophagitis Treatment: A Subgroup Analysis from the Pivotal Trial Eos-1