Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry.

BACKGROUND: Swallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses. OBJECTIVE: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice. METHODS: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations. RESULTS: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness. CONCLUSION: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.

Liver enzyme alteration in response to dengue virus.

Infectious diseases are extremely important in the global health landscape, specifically dengue and its severe forms. Clinical characterization is very variable due to the wide spectrum of manifestations the virus induces. Dengue is a viral infection caused by the dengue virus and is transmitted to humans by mosquitos of the Aedes family. Dengue is the most important arthropod-borne disease and if symptoms occur, could appear suddenly, characterized by biphasic fever, headache, retroocular pain, pain in various parts of the body, prostration and rash. It has also been described that the Dengue virus can also cause liver dysfunction that could vary from mild injury to severe hepatocyte injury, commonly in tropical and subtropical climates. We report the case of a 24-year-old female who came to the emergency room due to fever and myalgia, in the context of a recent trip to Cuba. Physical examination included positive tourniquet test and laboratory findings showed anaemia and thrombocytopenia, as well as elevated transaminase levels. Serologic tests for dengue virus are requested and a positive result of specific antibodies-IgM classified the patient as presumptive being necessary to confirm authorities the outbreak and explain the patient it requires a close monitoring. Abdominal ultrasound showed mild splenomegaly. Because of progressive analytical normalization, the patient asked for outpatient care.

Dieulafoy’s lesion in the cecal pole diagnosed by video-capsule endoscopy. A rare cause of lower gastrointestinal bleeding / Lesión de Dieulafoy en el cecal polo diagnosticado por videocápsula endoscopia. Una causa rara de sangrado gastrointestinal bajo

Dieulafoy's lesion is a rare vascular malformation that can cause massive acute gastrointestinal hemorrhage threatening the patient's life. This correspondence to the editor outlines the clinical presentation of a patient in whom, owing to the utilization of capsule endoscopy followed by subsequent colonoscopy, a diagnosis of hemorrhage resulting from a Dieulafoy's lesion located in the colon, a relatively uncommon site, was successfully established. Following intervention involving the application of hemoclips, the patient experienced a favorable clinical evolution.(AU)

Dieulafoy's lesion in the cecal pole diagnosed by video-capsule endoscopy. A rare cause of lower gastrointestinal bleeding.

Dieulafoy's lesion is a rare vascular malformation that can cause massive acute gastrointestinal hemorrhage threatening the patient's life. This correspondence to the editor outlines the clinical presentation of a patient in whom, owing to the utilization of capsule endoscopy followed by subsequent colonoscopy, a diagnosis of hemorrhage resulting from a Dieulafoy's lesion located in the colon, a relatively uncommon site, was successfully established. Following intervention involving the application of hemoclips, the patient experienced a favorable clinical evolution.

Blue rubber bleb nevus syndrome.

Gastrointestinal bleeding of obscure origin accounts for less than 5% of gastrointestinal hemorrhages. It is typically difficult to diagnose due to limited accessibility through standard endoscopic techniques and generally requires a significant number of procedures to reach a diagnosis. The "blue rubber bleb nevus syndrome" is a rare condition, of a probably hereditary origin, characterized by the presence of multiple hemangiomatous lesions, which can manifest as gastrointestinal bleeding of obscure origin. These lesions are generally nodular, rubbery to the touch, and have a submucosal appearance, primarily affecting the skin and gastrointestinal tract. We present the case of a 72-year-old male who was investigated for iron deficiency anemia with upper and lower gastrointestinal endoscopies conducted on two occasions, without revealing any findings that could explain the condition. Subsequently, a study with video-capsule endoscopy was performed, which revealed multiple submucosal and vascular lesions, measuring between 3-5 mm, located in the distal duodenum and jejunum, consistent with "Blue rubber bleb nevus syndrome".

Detection of Neuroendocrine Tumours by Enteroscopy: A Case Report.

We present the case of a 62-year-old patient who developed melenas and in whom conventional endoscopic tests could not detect any bleeding lesion. In our case, capsule endoscopy and enteroscopy were the pivotal elements in establishing the diagnosis of a neuroendocrine tumour with an atypical location. As a result, it was possible to surgically remove the lesions at an early stage of the malignancy without metastatic disease and without the need for adjuvant therapy. Our case demonstrates the need for these new techniques in tumours of atypical location and aggressive course. Otherwise, this malignancy may be underdiagnosed until an advanced stage.