CA : A Cancer Journal for Clinicians

http://incan-mexico.org/incan/pub/docencia/educacion-medica/articulos/esofago/GUIASBARRETAGA.pdf

Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus.

Improvements in genomic and molecular methods are expanding the range of potential applications for circulating tumour DNA (ctDNA), both in a research setting and as a 'liquid biopsy' for cancer management. Proof-of-principle studies have demonstrated the translational potential of ctDNA for prognostication, molecular profiling and monitoring. The field is now in an exciting transitional period in which ctDNA analysis is beginning to be applied clinically, although there is still much to learn about the biology of cell-free DNA. This is an opportune time to appraise potential approaches to ctDNA analysis, and to consider their applications in personalized oncology and in cancer research.

/pdf/liquid-biopsies-come-of-age-towards-implementation-of-3ovu7jzn3f.pdf

Liquid biopsies come of age: towards implementation of circulating tumour DNA

Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment.

Tremendous progress has been made in our understanding of food-based allergic disorders over the past 5 years. Recent epidemiologic studies suggest that nearly 4% of Americans are afflicted with food allergies, a prevalence much higher than appreciated in the past. In addition, the prevalence of peanut allergy was found to have doubled in American children less than 5 years of age in the past 5 years. Many food allergens have been characterized at the molecular level, which has contributed to our increased understanding of the immunopathogenesis of many allergic disorders and might soon lead to novel diagnostic and immunotherapeutic approaches. The management of food allergies continues to consist of educating patients on how to avoid relevant allergens, to recognize early symptoms of an allergic reaction in case of an accidental ingestion, and to initiate the appropriate emergency therapy. However, the recent successful clinical trial of anti-IgE therapy in patients with peanut allergy and the number of immunomodulatory therapies in the pipeline provide real hope that we will soon be able to treat patients with food allergy.

https://www.jacionline.org/article/S0091-6749(04)01145-5/pdf

Update on food allergy

Benign Disease of the Oesophagus

Eosinophilic esophagitis is a chronic inflammatory disease associated with dense esophageal eosinophilia, hyperplastic epithelia and subepithelial fibrosis [1]. As clinical recognition of eosinophilic esophagitis (EoE) increases, so too do observations identifying complications of the disease and its treatments. For the purposes of this chapter, complications will be defined as unfavourable evolutions of chronic inflammation or untoward consequences of ongoing treatment. In this regard, partial or complete esophageal obstruction due to esophageal narrowings or food impaction and eating difficulties are two important complications of EoE. With respect to chronic treatment, the overall goal is to resolve symptoms and prevent EoE-related complications. But treatment endpoints have not been established and thus, the exact duration, frequency, expense and type treatments have not been formally established. Because of this lack of guidelines, clinicians are potentially faced with complications related to endoscopic procedures, medical treatments and nutritional restrictions. In this chapter, we will provide our interpretation of the literature and summary of our clinical experiences of these complications in children and adult patients with EoE.

Complications Associated with Eosinophilic Esophagitis

Die eosinophile Ösophagitis (EoE) zählt zu den eosinophilen Erkrankungen des Gastrointestinaltrakts (EGID). Innerhalb der eosinophilen Erkrankungen des Gastrointestinaltrakts (EGID) unterscheidet man die primären Formen (eosinophile Ösophagitis, eosinophile Gastritis, eosinophile Gastroenteritis/Kolitis) und sekundäre Formen, die infolge anderer Systemerkrankungen (z. B. Hypereosinophilensyndrom, Autoimmunerkrankungen, Morbus Crohn, Zöliakie), gastrointestinaler Infektionen (z. B. parasitär) oder medikamentenassoziiert auftreten können. Den primären Formen ist immer gemeinsam, dass sie nur diagnostiziert werden, wenn die sekundären Formen ausgeschlossen sind. 

Eosinophile Ösophagitis (EoE)

Bringing dietary therapy for eosinophilic oesophagitis under scientific scrutiny.

Background and study aims Eosinophilic oesophagitis (EoE) is a common disease with a significant impact on physical health and quality of life (QoL). Outcomes and management vary widely, with no agreed UK national guideline. This paper aims to describe an up-to-date description of demographics, clinical spectrum and outcomes for paediatric and adult patients with EoE from the North East of England between 2016 and 2019. Patients and methods Patients from two large University Hospitals and the specialist paediatric hospital for the North East of England with histologically or clinically confirmed EoE were included in this analysis. Data were collected retrospectively via electronic patient records. Remission was defined as either the resolution of symptoms or improvement on histology. Results Data were collected on 74 paediatric and 59 adult patients. Dysphagia was the most common presenting symptom in both groups, accounting for 51%–84% of all presentations. Proton pump inhibitors and dietary manipulation were the most common therapies associated with remission in children (95% of those achieving remission), whereas the use of swallowed topical steroids was more prevalent in the treatment of adults (55% achieving remission). Conclusions EoE is a complex disease and poses significant challenges. Outcomes vary widely and need to be tailored to individual patient groups. Dietary manipulation plays a major role in treatment for EoE, but this is likely to be challenging for patients, especially children. Future work should continue to assess the outcomes in EoE, including on QoL and potential novel targeted therapies.

https://fg.bmj.com/content/flgastro/early/2021/06/08/flgastro-2021-101814.full.pdf

Stephen Attwood

Papers

Benign Disease of the Oesophagus

Complications Associated with Eosinophilic Esophagitis

Eosinophile Ösophagitis (EoE)

Bringing dietary therapy for eosinophilic oesophagitis under scientific scrutiny.

Clinical spectrum of paediatric and adult eosinophilic oesophagitis in the North East of England from 2016 to 2019