Spurred by food allergies, two esophagus conditions stump doctors
One condition is called eosinophilic esophagitis, or EoE. The other is PPI-responsive esophageal eosinophilia, or PPI-REE. Symptoms for each condition include difficulty swallowing, persistent heartburn, and getting food stuck in the throat. Both are diagnosed with an endoscopy, which reveals high numbers of a certain type of white blood cell -- an eosinophil -- in biopsies of both conditions. But finding a lot of white blood cells does not distinguish EoE from PPI-REE, said Evan Dellon, MD, MPH, associate professor of medicine and epidemiology and lead author of a study published in the American Journal of Gastroenterology.
Dellon says that both conditions can be the result of a food allergy, but they require different treatments.
Patients whose white blood cell count can be lowered by antacid medications, also called proton-pump inhibitor (PPI) medications, are diagnosed with PPI-REE. However, finding out if the white blood cell count was lowered requires a second endoscopy and biopsy. If the count remained high, then patients are diagnosed with EoE and require an anti-inflammatory medication, such as a steroid typically used to treat asthma.
"Unfortunately, right now the only way to differentiate between the conditions is to do the PPI medication trial and then repeat the endoscopy," Dellon said.
During his study, Dellon's team wanted to see if any symptoms, endoscopic views of the esophagus, or tissue samples could help him differentiate the two conditions so that future patients wouldn't have to go through an eight-week antacid trial and a second endoscopic biopsy, an invasive procedure that is safe but costly and requires sedation.
The study enrolled 223 patients with esophageal complaints. Dellon's team took small samples of tissue from the patients and examined them for the presence of eosinophils -- white blood cells. Patients with a high eosinophil count were given an 8-week course of antacids. The study showed that approximately 30 to 40 percent of the participants responded to the antacid medication. They were diagnosed with PPI-REE.
Patients who did not respond to antacids were diagnosed with EoE. There are no FDA-approved medicines for EoE, so the steroids that doctors prescribe are considered off-label use. There are, however, several randomized, double-blind studies that show that these medications work for EoE.
"The other option for treating EoE is to try a variety of elimination diets to remove the most common food triggers, such as wheat, dairy, soy, or eggs," Dellon said. "We know that it's mostly an allergic reaction because if you take away all allergens, nearly everyone will get better very quickly. But that isn't a practical treatment for many people."
After rigorous analysis, Dellon and his colleagues did not find any clinical or endoscopic characteristics that could reliably distinguish the two conditions. This means patients will still need to undergo the PPI trial and repeat endoscopy in order to be properly diagnosed.
Dellon's team is working on an extension of this study that uses a special stain on the cell biopsies that he hopes will predict who will respond to antacids. Dellon also wants to investigate patient genetics as a possible diagnostic tool.
"This whole antacid response and even the existence of PPI-REE as a condition weren't really described well until two years ago," Dellon said. "So the diagnostics are still very much in flux right now."
Welcome to SUV System Ltd!
SUV System Ltd is ISO 90012008 Certified electronics distributor with 10 years of experiences.
We have built up long term business relationship with about many companies which are stockers and authorized agents. we have a steady and reliable supply to meet customer's demands to the greatest extent .Confidently, we are able to lower your cost and support your business with our years of professional service.
SUV System Ltd is Electronic Components Distributor Supplies,Find Quality Electronic Components Supplies Products IC(Integrated Circuits),Connectors,Capacitor,Resistors,Diodes,Transistors,LED at Suvsystem.com. Sourcing Other Energy, Environment, Excess Inventory Products from Manufacturers and Suppliers at Suvsystem.com
Electronic Components distributor:http://www.suvsystem.com
Connectors Distributor:http://www.suvsystem.com/l/Connectors-1.html
IC Distributor:http://www.suvsystem.com/l/IC(Integrated-Circuits)-1.html
LED Distributor:http://www.suvsystem.com/l/LED-1.html
Capacitor Distributor:http://www.suvsystem.com/l/Capacitor-1.html
Transistor Distributor:http://www.suvsystem.com/l/Transistors-1.html
Resistor Distributor:http://www.suvsystem.com/l/Resistors-1.html
Diode Distributor:http://www.suvsystem.com/l/Diodes-1.html
SUV System Ltd insists on the managing faith ofsincereness,speciality,foresight, win-win,so we build up stable-relationship customers located all over the world, including the States, Europe, Argentina, UAE, Malaysia, Australia,and India etc
we are focus on the following fields,and hope we can help you.
ALTERA IC LED ST Diodes IC(Integrated Circuits) IR transistor Fleld Effect Transistors ON Transistors INFLNEON Diodes Freescale Semiconductor PANASONIC Resistors High Precision Resistors TOSHIBA Diodes Low Ohmic Resistors Diodes Inc Ligitek LED Atmel IC LITTELFUSE Diodes Chip Ferrite Beads Vishay resistors MAXIM IC TOSHIBA Transistors Current Sensors Resistors ST Transistors Resistor Networks Switches BB IC LED part Capacitor YAGEO Resistors Transistors Voltage Regulators Transistors About US Connectors Electronic News Kingbrigt LED Xilinx IC ROHM Resistors NXP Transistors IDT IC VISHAY IC
http://www.suvsystem.com/a/8259.aspx
