Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the esophagus.Beside proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a firs...Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the esophagus.Beside proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a first line therapy according to current guidelines.This review describes the background and practical management of STCs in EoE.So far,mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications“off label”.Recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85%-an orodispersible tablet of budesonide has been approved as the first“in label”medication for EoE in Europe in June 2018.Whereas it was shown that disease remission induction of EoE by STCs is highly effective,there is still a lack of data regarding long-term and maintenance therapy.However,current studies on STC maintenance therapy add some movement into the game.展开更多
BACKGROUND Eosinophilic esophagitis(EoE)is a chronic inflammatory disorder presenting as symptoms of dysphagia,esophageal food impaction,chest pain,and heartburn.After an initial trial of proton pump inhibitor(PPI)the...BACKGROUND Eosinophilic esophagitis(EoE)is a chronic inflammatory disorder presenting as symptoms of dysphagia,esophageal food impaction,chest pain,and heartburn.After an initial trial of proton pump inhibitor(PPI)therapy,swallowed topical corticosteroids(STC)are effective as induction therapy for EoE.However,out-come data for STC as a maintenance strategy is limited.RESULTS Three randomized control trials and one observational study were included,involving 303 patients(189 in the STC group,114 in the placebo-controlled group).Analysis showed that histologic recurrence was significantly lower with STC(OR:0.04,95%CI:0.01-0.28,P<0.00001,I^(2)=78%).Overall symptom recurrence was similar between groups(OR:0.23,95%CI:0.02-3.54,P=0.29,I^(2)=92%).On sensitivity analysis,symptom recurrence was significantly lower in the STC group(OR:0.05,95%CI:0.02-0.17,P=0.00001,I^(2)=39%).Odds of repeat dilation were significantly lower in the STC group(OR:0.14,95%CI:0.02-0.91,P=0.04,I^(2)=0%).Candida infection rates were similar between groups(OR:6.13,95%CI:0.85-44.26,P=0.07,I^(2)=24%).Proportion of concomitant PPI use was similar between groups(OR:1.64,95%CI:0.83-3.21,P=0.15,I^(2)=0%).CONCLUSION For patients who successfully achieved remission of EoE with STC induction therapy,maintaining treatment is effective in sustaining histologic remission,while newer regimens may be effective in preventing symptom recurrence compared to placebo.We found no significant difference for oropharyngeal/esophageal candidiasis with STC maintenance therapy.Future studies with longer follow-up periods are needed.展开更多
To the Editor:Upadacitinib,an oral janus kinase(JAK)inhibitor,exhibits a higher inhibitory potency for JAK1 compared to JAK2,JAK3,or tyrosine kinase 2,making it a promising candidate for the treatment of atopic dermat...To the Editor:Upadacitinib,an oral janus kinase(JAK)inhibitor,exhibits a higher inhibitory potency for JAK1 compared to JAK2,JAK3,or tyrosine kinase 2,making it a promising candidate for the treatment of atopic dermatitis(AD).Global trials Measure Up 1,Measure Up 2,and AD Up have demonstrated efficacy and safety data for moderate-to-severe AD,both as monotherapy and in combination with topical corticosteroids(TCS).[1,2]The updated 52-week results preliminarily reported sustained clinical benefits over 52 weeks,[3,4]but data on long-term outcomes in Chinese patients remain limited.Ethnic differences in AD pathophysiology,including variations in immune signatures,underscore the need for region-specific evidence.[5]This post hoc analysis of Measure Up 1 and AD Up trials evaluates the 140-week efficacy and safety of upadacitinib in Chinese patients.展开更多
Introduction Cuffitis is a common phenotype of inflammatory disorder located at the rectal cuff of ileal pouch-anal anastomosis(IPAA)in those with underlying ulcerative colitis(UC)[1,2].Classic cuffitis is considered ...Introduction Cuffitis is a common phenotype of inflammatory disorder located at the rectal cuff of ileal pouch-anal anastomosis(IPAA)in those with underlying ulcerative colitis(UC)[1,2].Classic cuffitis is considered a form of remnant UC following IPAA without mucosectomy.Patients with cuffitis usually respond to topical mesalamine or topical corticosteroid therapy[3,4].Cuffitis can result from other etiologies,such as Crohn’s disease(CD)and prolapse,which often present with asymmetric distribution of the cuff inflammation[1,5].Common symptoms of cuffitis are urgency,frequency,bleeding,and pelvic pressure.Despite advances in the diagnosis and management of ileal pouch disorders,some patients with cuffitis poorly respond to topical and systemic medical therapy.In this brief report,we describe a case in which cuffitis was resolved by the removal of dislodged surgical staples from the anastomosis,suggesting a contributing role of the staples in cuffitis.展开更多
文摘Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the esophagus.Beside proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a first line therapy according to current guidelines.This review describes the background and practical management of STCs in EoE.So far,mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications“off label”.Recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85%-an orodispersible tablet of budesonide has been approved as the first“in label”medication for EoE in Europe in June 2018.Whereas it was shown that disease remission induction of EoE by STCs is highly effective,there is still a lack of data regarding long-term and maintenance therapy.However,current studies on STC maintenance therapy add some movement into the game.
文摘BACKGROUND Eosinophilic esophagitis(EoE)is a chronic inflammatory disorder presenting as symptoms of dysphagia,esophageal food impaction,chest pain,and heartburn.After an initial trial of proton pump inhibitor(PPI)therapy,swallowed topical corticosteroids(STC)are effective as induction therapy for EoE.However,out-come data for STC as a maintenance strategy is limited.RESULTS Three randomized control trials and one observational study were included,involving 303 patients(189 in the STC group,114 in the placebo-controlled group).Analysis showed that histologic recurrence was significantly lower with STC(OR:0.04,95%CI:0.01-0.28,P<0.00001,I^(2)=78%).Overall symptom recurrence was similar between groups(OR:0.23,95%CI:0.02-3.54,P=0.29,I^(2)=92%).On sensitivity analysis,symptom recurrence was significantly lower in the STC group(OR:0.05,95%CI:0.02-0.17,P=0.00001,I^(2)=39%).Odds of repeat dilation were significantly lower in the STC group(OR:0.14,95%CI:0.02-0.91,P=0.04,I^(2)=0%).Candida infection rates were similar between groups(OR:6.13,95%CI:0.85-44.26,P=0.07,I^(2)=24%).Proportion of concomitant PPI use was similar between groups(OR:1.64,95%CI:0.83-3.21,P=0.15,I^(2)=0%).CONCLUSION For patients who successfully achieved remission of EoE with STC induction therapy,maintaining treatment is effective in sustaining histologic remission,while newer regimens may be effective in preventing symptom recurrence compared to placebo.We found no significant difference for oropharyngeal/esophageal candidiasis with STC maintenance therapy.Future studies with longer follow-up periods are needed.
文摘To the Editor:Upadacitinib,an oral janus kinase(JAK)inhibitor,exhibits a higher inhibitory potency for JAK1 compared to JAK2,JAK3,or tyrosine kinase 2,making it a promising candidate for the treatment of atopic dermatitis(AD).Global trials Measure Up 1,Measure Up 2,and AD Up have demonstrated efficacy and safety data for moderate-to-severe AD,both as monotherapy and in combination with topical corticosteroids(TCS).[1,2]The updated 52-week results preliminarily reported sustained clinical benefits over 52 weeks,[3,4]but data on long-term outcomes in Chinese patients remain limited.Ethnic differences in AD pathophysiology,including variations in immune signatures,underscore the need for region-specific evidence.[5]This post hoc analysis of Measure Up 1 and AD Up trials evaluates the 140-week efficacy and safety of upadacitinib in Chinese patients.
文摘Introduction Cuffitis is a common phenotype of inflammatory disorder located at the rectal cuff of ileal pouch-anal anastomosis(IPAA)in those with underlying ulcerative colitis(UC)[1,2].Classic cuffitis is considered a form of remnant UC following IPAA without mucosectomy.Patients with cuffitis usually respond to topical mesalamine or topical corticosteroid therapy[3,4].Cuffitis can result from other etiologies,such as Crohn’s disease(CD)and prolapse,which often present with asymmetric distribution of the cuff inflammation[1,5].Common symptoms of cuffitis are urgency,frequency,bleeding,and pelvic pressure.Despite advances in the diagnosis and management of ileal pouch disorders,some patients with cuffitis poorly respond to topical and systemic medical therapy.In this brief report,we describe a case in which cuffitis was resolved by the removal of dislodged surgical staples from the anastomosis,suggesting a contributing role of the staples in cuffitis.
