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Gomez Torrijos E, Gonzalez-Mendiola R, Alvarado M, Avila R, Prieto-Garcia A, Valbuena T, Borja J, Infante S, Lopez MP, Marchan E, Prieto P, Moro M, Rosado A, Saiz V, Somoza ML, Uriel O, Vazquez A, Mur P, Poza-Guedes P, Bartra J. Eosinophilic Esophagitis: Review and Update. Front Med (Lausanne) 2018; 5:247. [PMID: 30364207 PMCID: PMC6192373 DOI: 10.3389/fmed.2018.00247] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Eosinophilic esophagitis (EoE) was first described in the 1990s, showing an increasing incidence and prevalence since then, being the leading cause of food impaction and the major cause of dysphagia. Probably, in a few years, EoE may no longer be considered a rare disease. Methods: This article discusses new aspects of the pathogenesis, symptoms, diagnosis, and treatment of EoE according to the last published guidelines. Results: The epidemiological studies indicate a multifactorial origin for EoE, where environmental and genetic factors take part. EoE affects both children and adults and it is frequently associated with atopic disease and IgE-mediated food allergies. In patients undergoing oral immunotherapy for desensitization from IgE-mediated food allergy the risk of developing EoE is 2.72%. Barrier dysfunction and T-helper 2 inflammation is considered to be pathogenetically important factors. There are different patterns of clinical presentation varying with age and can be masked by adaptation habits. Besides, symptoms do not usually correlate with histologic disease activity. The diagnostic criteria for EoE has evolved but mainly requires symptoms of esophageal dysfunction with histologic evidence of a peak value of at least 15 eosinophils per high-power field. Endoscopies have to be repeated in order to diagnose, monitor, and treat EoE. Treatment of EoE can be started either by drugs (PPIs and topical corticosteroids) or elimination diets. The multistage step-up elimination diet management approach of EoE is promising. Endoscopic dilation is used for patients with severe dysphagia/food impaction with inadequate response to anti-inflammatory treatment. Conclusions: Research in recent years has contributed to a better understanding of EoE's pathogenesis, genetic background, natural history, allergy workup, standardization in assessment of disease activity, evaluation of minimally invasive diagnostic tools, and new therapeutic approaches. However, several unmet needs are to be solved urgently, as finding a non-invasive disease-monitoring methods and biomarkers for routine practice, the development or new therapies, novel food allergy testing to detect triggering foods, drug, and doses required for initial therapy and safety issues with long-term maintenance therapy, amongst others. Besides, multidisciplinary management units of EoE, involving gastroenterologists, pediatricians, allergists, pathologists, dietitians, and ENT specialists are needed.
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Affiliation(s)
| | | | | | - Robledo Avila
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Jesus Borja
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - M. Pilar Lopez
- Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Mar Moro
- Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Ana Rosado
- Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Vanessa Saiz
- Hospital UniversitarioReina Sofía de Córdoba, Cordoba, Spain
| | | | - Olga Uriel
- Hospital Universitario de Araba, Vitoria-Gasteiz, Spain
| | - Angelina Vazquez
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pilar Mur
- Hospital Santa Barbara, Puertollano, Spain
| | - Paloma Poza-Guedes
- Allergy Section, Hospital Universitario de La Laguna, San Cristóbal de La Laguna, Spain
| | - Joan Bartra
- Allergy Section, Pneumology Department, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
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Peñuelas E, Serrano P, Barasona MJ, Saiz V, Fernandez L, Moreno C. Sensitization to Minor Allergens Has a Direct Influence on the Outcome of Subcutaneous Immunotherapy in Olive-Allergic Patients. J Investig Allergol Clin Immunol 2016; 26:202-4. [PMID: 27326994 DOI: 10.18176/jiaci.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E Peñuelas
- Immunology-Allergy Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - P Serrano
- Immunology-Allergy Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - M J Barasona
- Immunology-Allergy Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - V Saiz
- Immunology-Allergy Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - L Fernandez
- Immunology-Allergy Unit, Reina Sofía University Hospital, Córdoba, Spain
| | - C Moreno
- Immunology-Allergy Unit, Reina Sofía University Hospital, Córdoba, Spain
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Livianos L, González-Valls PI, García-Blanco AC, Tobella H, Díaz-Alonso I, Alberola N, García-Aznar S, Bellot R, Saiz V, Ros L. Hypoesthesia of the malleolus as a soft sign in depression. J Affect Disord 2015; 171:128-31. [PMID: 25305426 DOI: 10.1016/j.jad.2014.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/15/2014] [Accepted: 09/20/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical signs often are present in many psychiatric conditions, making up a fundamental part of them and accompanying the psychiatric manifestations themselves. Identifying minor neurological signs is especially of interest due to they are easily accessible through simple neurological examination and could be a useful if underused tool for the diagnostic process and patient therapy. METHOD A group of depressed patients (n=85) and group of healthy individuals (n=101) that served as control were examined using the Wartenberg wheel, a medical device for neurological use, in order to determine the presence of hypoesthesia on both sides of their ankles. RESULTS The data revealed: (i) patients with depression are generally more likely to present malleolar hypoesthesia than healthy participants; and (ii) participants who presented malleolar hypoesthesia presented greater depressive symptomatology as well as greater anxiety symptomatology at the time of assessment. LIMITATIONS Although all patients in this study were taking psychotropic medication, anxiolytics and antidepressants are not associated with skin sensitivity. As is usual, the categorization of hypoesthesia is based on participant subjectivity. However, this subjectivity cannot explain the differences between depressed patients and healthy individuals. CONCLUSIONS The present findings corroborate that localized tactile sensitivity is altered in depression and correlates with anxiety-depressive symptomatology, even on a subclinical level. The observation of neurological soft signs such as the detection of malleolar hypoesthesia in patients with depressive symptomatology is easily accessible using a simple neurological examination, and it could became a powerful tool that could provide objective information on affective disorders.
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Affiliation(s)
- Lorenzo Livianos
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain; University of Valencia, Department of Medicine, Valencia, Spain; CIBERESP, Spain
| | - Pablo I González-Valls
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Ana C García-Blanco
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain.
| | - Helena Tobella
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Ignacio Díaz-Alonso
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Núria Alberola
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Susana García-Aznar
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Ramón Bellot
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Vanessa Saiz
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
| | - Lourdes Ros
- Department of Psychiatry, La Fe University and Polytechnic Hospital, 46010 Valencia, Spain
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Morales P, Ros JA, Blanes M, Pérez-Enguix D, Saiz V, Santos M. Successful recovery after disseminated infection due to mycobacterium abscessus in a lung transplant patient: subcutaneous nodule as first manifestation--a case report. Transplant Proc 2007; 39:2413-5. [PMID: 17889205 DOI: 10.1016/j.transproceed.2007.07.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mycobacterium abscessus infection following lung transplantation (LT) has been described in a few cases. It is characterized by a variable initial location and subsequent course in this special risk group of patients, particularly those with cystic fibrosis (CF). Herein we have presented the case of a patient subjected to LT due to CF, who 1 year after transplantation developed a subcutaneous nodule produced by M abscessus, with subsequent hematogenous spread as well as bronchial and bone marrow involvement. Antecedents prior to LT included Staphylococcus aureus colonization and sputum positivity for Aspergillus fumigatus and Scedosporium apioespermum. Treatment with ciprofloxacin and linezolid was started on the basis of the antibiogram findings. The latter antibiotic was replaced by clarithromycin for 6 months. Two years later, the patient remains asymptomatic with respiratory function parameters in the normal range. The infected patient described herein was our only case with sepsis and multisystemic spread. The important mortality among such cases reported in the literature makes early diagnosis and treatment essential.
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Affiliation(s)
- P Morales
- Unidad de Trasplante Pulmonar, Hospital Universitario la Fe, Valencia, Spain.
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Morales P, Ros J, Blanes M, Saiz V, Pérez-Enguix D, Santos M. 146 Mycobacterium abscessus infection in lung transplant patients: Review of our series. J Cyst Fibros 2007. [DOI: 10.1016/s1569-1993(07)60132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pérez-Garrigues H, Genovés JM, Benavides M, Saiz V, Mateos M, Morera C. [Medium and large acoustic neurinomas with normal tonal audiometry at the moment of diagnosis]. Rev Neurol 2000; 31:1126-30. [PMID: 11205543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Early diagnosis of an acoustic neurinoma for any possible treatment is important, especially in view of the relationship between surgical morbidity and the size of the tumour. The commonest presenting symptom of these tumors is unilateral perceptive deafness. However, between 4 and 12% are diagnosed before deafness occurs, although they may be large in size. Therefore one should remember other symptoms which lead to suspicion of these tumors, and have diagnostic guidelines available to allow the earliest possible detection. PATIENTS AND METHODS We report four cases of acoustic neurinoma or vestibular schwannoma of medium or large size in which audiological studies did not at first give rise to suspicion of the presence of this tumour, since audition was considered to be normal at conversation frequencies (500 to 3,000 Hertz) for the age of the patient or who had an audiometry curve with symmetrical deafness in both ears. CONCLUSION We evaluated the diagnostic importance of the tests done and compared the results with data published in the literature.
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Affiliation(s)
- H Pérez-Garrigues
- Servicio de Otorrinolaringología, Hospital Universitario La Fe, Valencia, España
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Benavides Gabernet M, Morera Faet H, Saiz V, Mateos M, Collado D, Pérez A, Morera Pérez C. [Primary tuberculous otitis media]. Acta Otorrinolaringol Esp 2000; 51:255-8. [PMID: 10867403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Tuberculous otitis media is now an infrequent disease, with an incidence of less than 1%. In most cases the origin is a pulmonary focus and primary cases are rarer. We report a case of primary tuberculous otitis media in an immunocompetent patient. A bibliographic review was made of clinical and etiopathogenic aspects, as well as diagnosis and treatment. We highlight the diagnostic difficulty and the fact that this entity should be included in the differential diagnosis of persistent suppurative otitis media.
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Pérez Garrigues H, Genovés J, Benavides M, Saiz V, Mateos M, Morera Pérez C. Neurinomas acústicos medianos y grandes con audiometría tonal normal en el momento del diagnóstico. Rev Neurol 2000. [DOI: 10.33588/rn.3112.2000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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