Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner.

BACKGROUND & AIMS: Development of strictures is a major concern for patients with eosinophilic esophagitis (EoE). At diagnosis, EoE can present with an inflammatory phenotype (characterized by whitish exudates, furrows, and edema), a stricturing phenotype (characterized by rings and stenosis), or a combination of these. Little is known about progression of stricture formation; we evaluated stricture development over time in the absence of treatment and investigated risk factors for stricture formation. METHODS: We performed a retrospective study using the Swiss EoE Database, collecting data on 200 patients with symptomatic EoE (153 men; mean age at diagnosis, 39 ± 15 years old). Stricture severity was graded based on the degree of difficulty associated with passing of the standard adult endoscope. RESULTS: The median delay in diagnosis of EoE was 6 years (interquartile range, 2-12 years). With increasing duration of delay in diagnosis, the prevalence of fibrotic features of EoE, based on endoscopy, increased from 46.5% (diagnostic delay, 0-2 years) to 87.5% (diagnostic delay, >20 years; P = .020). Similarly, the prevalence of esophageal strictures increased with duration of diagnostic delay, from 17.2% (diagnostic delay, 0-2 years) to 70.8% (diagnostic delay, >20 years; P < .001). Diagnostic delay was the only risk factor for strictures at the time of EoE diagnosis (odds ratio = 1.08; 95% confidence interval: 1.040-1.122; P < .001). CONCLUSIONS: The prevalence of esophageal strictures correlates with the duration of untreated disease. These findings indicate the need to minimize delay in diagnosis of EoE.

Venlafaxine-induced cholestatic hepatitis: case report and review of literature.

Venlafaxine is a widely used antidepressant with relatively low occurrence of adverse side effects. Increasing evidence suggests that venlafaxine may cause severe liver damage. Until now, 10 cases of venlafaxine-related liver injuries have been reported. We describe a case of a 39-year-old woman who developed cholestatic hepatitis after intake of venlafaxine. The patient had taken low-dose venlafaxine (75 mg/d) for 2.5 years. Three months before admission to the hospital, the venlafaxine dosage had been increased to 300 mg/d because of severe depression. Laboratory findings revealed elevated serum transaminases (aspartate aminotransferase 1033 U/L; alanine aminotransferase 2063 U/L), alkaline phosphatase (274 U/L), γ-glutamyltransferase (284 U/L), and serum bilirubin (4.6 mg/dL). Liver biopsy showed cholestatic hepatitis predominantly involving zone 3 of hepatic acini and a mixed portal inflammatory infiltrate along with eosinophils. Symptoms rapidly resolved after cessation of venlafaxine and administration of corticosteroid. The present paper describes detailed clinicohistopathologic characteristics of venlafaxine-associated cholestatic hepatitis and provides a comprehensive summary of prior case reports.

Colon Capsule Endoscopy compared to Conventional Colonoscopy under routine screening conditions.

BACKGROUND: Colonoscopy (CSPY) for colorectal cancer screening has several limitations. Colon Capsule Endoscopy (PillCam Colon, CCE) was compared to CSPY under routine screening conditions. METHODS: We performed a prospective, single-center pilot study at a University Hospital. Data were obtained from November 2007 until May 2008. Patients underwent CCE on Day 1 and CSPY on Day 2. Outcomes were evaluated regarding sensitivity and specificity of polyp detection rate, with a significance level set at >5 mm. RESULTS: 59 individuals were included in this study, the results were evaluable in 56 patients (males 34, females 22; median age 59). CCE was complete in 36 subjects. Polyp detection rate for significant polyps was 11% on CSPY and 27% on CCE.6/56 (11%) patients had polyps on CSPY not detected on CCE (miss rate).Overall sensitivity was 79% (95% confidence interval [CI], 61 to 90), specificity was 54% (95% CI, 35 to 70), positive predictive value (PPV) was 63% and negative predictive value (NPV) was 71%. Adjusted to significance of findings, sensitivity was 50% (95% CI, 19 to 81), specificity was 76% (95% CI, 63 to 86), PPV was 20% and NPV was 93%. CONCLUSION: In comparison to the gold standard, the sensitivity of CCE for detection of relevant polyps is low, however, the high NPV supports its role as a possible screening tool. TRIAL REGISTRATION: NCT00991003.