Alex Straumann - Academia.edu (original) (raw)
Papers by Alex Straumann
Endoscopy, Feb 1, 2008
Strictures are a frequent complication of eosinophilic esophagitis. The efficacy and safety of to... more Strictures are a frequent complication of eosinophilic esophagitis. The efficacy and safety of topical corticosteroids and of dilation of eosinophilic esophagitis-associated strictures have not yet been thoroughly clarified. We present a retrospective analysis of 10 adult patients with eosinophilic esophagitis who had symptomatic esophageal stenosis that was unresponsive to topical corticosteroids, and who were treated using bougienage. Eight patients had one single stricture, one patient had two, and another had three strictures; mean stricture length was 2.1 cm (range 1 - 6 cm). Bougienage led to prompt symptom relief. Apart from transient postprocedural odynophagia, no severe complications occurred. During the follow-up (mean 6 months; range 2 - 11 months), all patients enjoyed sustained treatment response.
Turkiye Klinikleri Allerji Astım Dergisi, 2004
Journal of Allergy and Clinical Immunology, 2009
European Journal of Gastroenterology Hepatology, Oct 1, 2007
Eosinophilic oesophagitis (EO) is a chronic inflammatory disorder of the oesophagus that is rapid... more Eosinophilic oesophagitis (EO) is a chronic inflammatory disorder of the oesophagus that is rapidly increasing in prevalence. Although systemic and topical corticosteroids are effective in treating EO, some patients develop corticosteroid dependency. Alternative therapeutic approaches that avoid corticosteroids are scarce. To analyse our experience at inducing and maintaining remission with an immunomodulatory therapy in steroid-dependent EO patients. We analysed the clinical and histological response to azathioprine (AZA) and 6-mercaptopurine in three patients with EO (one also with eosinophilic gastroenteritis) and corticosteroid dependency. In all three patients, AZA or 6-mercaptopurine-induced clinical and histological remission that was maintained during the follow-up period (range 3-8 years). Two patients experienced relapses after ceasing AZA therapy. Remission, however, resumed when short-term corticosteroid treatment was followed by AZA. In all the patients, blood eosinophilia disappeared under AZA treatment. Only jumbo biopsies confirmed suspected EO with predominant muscle-layer involvement in one patient. In adult patients with corticosteroid-dependent EO, immunomodulatory treatment with purine analogues is a promising therapeutic approach for inducing and maintaining long-term remission without the need for further corticosteroids. Jumbo forcep biopsies might be needed to confirm a diagnosis of muscle-layer predominant EO.
Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. Th... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your work, please use the accepted author's version for posting to your own website or your institution's repository. You may further deposit the accepted author's version on a funder's repository at a funder's request, provided it is not made publicly available until 12 months after publication.
J Allerg Clin Immunol, 2008
Background: In pilot studies, PillCam COLON capsule endoscopy (PCCE) has been shown feasible and ... more Background: In pilot studies, PillCam COLON capsule endoscopy (PCCE) has been shown feasible and able to demonstrate colon polyps and cancers and has the potential of being performed outside of medical units. An 8-center prospective study with a target of 329 patients is ongoing in Europe. The primary objective is to assess the yield of PCCE in detecting polyps and other pathologies in comparison to traditional colonoscopy. This study reports the first planned interim analysis. Methods: Patients included in this study were known to have (age older than 18 years) or suspected of having (age older than 50 years) colonic disease and were referred for colonoscopy. Patients went through a traditional polyethylene glycol colon preparation and ingested the capsule in the morning. The procedure included prokinetic agents and additional small doses of laxatives. Independent physicians performed capsule imaging analysis and traditional colonoscopy ("gold standard") after excretion. Significant findings were defined as at least one polyp Ն6 mm or Ն3 polyps of any size. Results: Eighty-four patients, with a mean age of 60 (23-84) years, were included and analyzed for this interim analysis. Capsules were expelled within 8 hours postingestion in 91% of patients, and an additional 9% reached the rectosigmoid. Quality of colon preparation in PCCE was evaluated as excellent to good (66%), fair (29%), and poor (6%). Fifty-nine patients (70%) had a polyp of any size, and 38 (45%) had significant findings detected by colonoscopy. The yield of PCCE compared with colonoscopy is shown in . Six polyps were detected only by PCCE. No adverse events related to PCCE were reported.
Journal of Allergy and Clinical Immunology, 2001
Background: Idiopathic eosinophilic esophagitis (IEE) is a chronic-inflammatory disorder of the e... more Background: Idiopathic eosinophilic esophagitis (IEE) is a chronic-inflammatory disorder of the esophagus of unknown origin. The established cornerstone of diagnosis is a dense infiltration of the esophagus with eosinophils, but neither the precise pattern of inflammatory cell infiltration nor the mechanisms that likely contribute to induction and maintenance of the inflammatory response have been described. Objective: The intention of this study was to characterize the esophageal inflammatory infiltrate and the expression of cytokines in the esophagus in this disease. In addition, we searched for immunologic abnormalities of blood leukocytes to exclude major primary hyporeactive and hyperreactive conditions of the immune system. Methods: Infiltration of inflammatory cells in the esophagus, stomach, and duodenum was analyzed by immunohistochemistry through use of mAbs against lineage-associated molecules. Cytokine expression was measured by ELISA and immunohistochemical analysis. Lymphocyte subpopulations in blood were determined by means of flow cytometry. Results: High eosinophil infiltration into the esophageal squamous epithelium was observed in patients with IEE but not in control subjects. Interestingly, increased T-cell and mast cell numbers were also found within the epithelium in these patients. In contrast, the numbers of inflammatory cells were not increased in the stomach and duodenum in patients with IEE, suggesting a specific inflammatory process within the esophagus. Moreover, increased expression of IL-5 and TNF-α was observed in esophageal epithelial biopsy specimens. The distribution of lymphocyte subsets in the peripheral blood and their capacity to generate cytokines did not reflect the changes observed at the inflammatory site. Conclusions: IEE is a selective inflammatory response of the esophagus. T cells, IL-5, eosinophils, and IgE-mediated mechanisms appear to be involved, giving rise to the possibility that allergic reactions might play a role in the pathogenesis of the disease. (J Allergy Clin Immunol 2001;108:954-61.)
J Allerg Clin Immunol, 2002
Background: Idiopathic eosinophilic esophagitis (IEE) is a chronic-inflammatory disorder of the e... more Background: Idiopathic eosinophilic esophagitis (IEE) is a chronic-inflammatory disorder of the esophagus of unknown origin. The established cornerstone of diagnosis is a dense infiltration of the esophagus with eosinophils, but neither the precise pattern of inflammatory cell infiltration nor the mechanisms that likely contribute to induction and maintenance of the inflammatory response have been described. Objective: The intention of this study was to characterize the esophageal inflammatory infiltrate and the expression of cytokines in the esophagus in this disease. In addition, we searched for immunologic abnormalities of blood leukocytes to exclude major primary hyporeactive and hyperreactive conditions of the immune system. Methods: Infiltration of inflammatory cells in the esophagus, stomach, and duodenum was analyzed by immunohistochemistry through use of mAbs against lineage-associated molecules. Cytokine expression was measured by ELISA and immunohistochemical analysis. Lymphocyte subpopulations in blood were determined by means of flow cytometry. Results: High eosinophil infiltration into the esophageal squamous epithelium was observed in patients with IEE but not in control subjects. Interestingly, increased T-cell and mast cell numbers were also found within the epithelium in these patients. In contrast, the numbers of inflammatory cells were not increased in the stomach and duodenum in patients with IEE, suggesting a specific inflammatory process within the esophagus. Moreover, increased expression of IL-5 and TNF-α was observed in esophageal epithelial biopsy specimens. The distribution of lymphocyte subsets in the peripheral blood and their capacity to generate cytokines did not reflect the changes observed at the inflammatory site. Conclusions: IEE is a selective inflammatory response of the esophagus. T cells, IL-5, eosinophils, and IgE-mediated mechanisms appear to be involved, giving rise to the possibility that allergic reactions might play a role in the pathogenesis of the disease. (J Allergy Clin Immunol 2001;108:954-61.)
Der Pathologe, Mar 1, 2013
Eosinophilic esophagitis is characterized by symptoms of esophageal dysfunction and eosinophil-pr... more Eosinophilic esophagitis is characterized by symptoms of esophageal dysfunction and eosinophil-predominant esophageal inflammation. Eosinophilic inflammation in other parts of the gastrointestinal tract is absent and several differential diagnoses for esophageal eosinophilia have to be excluded before diagnosing eosinophilic esophagitis. Most patients are male and have concomitant atopic disorders. Therapeutic options are based on drugs, diet and dilation.
Current Opinion in Gastroenterology, Jun 1, 2009
Eosinophilic esophagitis (EoE) is a relatively new chronic inflammatory disease of the esophagus.... more Eosinophilic esophagitis (EoE) is a relatively new chronic inflammatory disease of the esophagus. Novel aspects in the diagnosis and treatment of EoE are discussed in this review. Development of diagnostic guidelines consisting of symptoms as well as endoscopic and histopathologic criteria has improved the awareness of clinicians and the diagnosing of EoE. The clinically challenging discrimination of EoE from gastroesophageal reflux disease has become more obvious and has evoked the need for more individualized therapy options. Today, most patients with EoE can be treated successfully with topical corticosteroids. However, no convincing alternative treatment strategies exist for corticosteroid-refractory or corticosteroid-dependent patients. Interestingly, a single-nucleotide polymorphism in the eotaxin-3 gene has been linked to increased disease susceptibility for EoE. EoE is an emerging esophageal disease. A better understanding of the pathogenesis of this disorder would improve the clinical recognition and diagnostic ability and ultimately provide patients with more optimal treatment options.
Current Treatment Options in Gastroenterology, 2016
The activity of a particular esophageal disease, such as eosinophilic esophagitis (EoE) or achala... more The activity of a particular esophageal disease, such as eosinophilic esophagitis (EoE) or achalasia, can be evaluated using clinician-reported outcome (ClinRO) measures assessing various endoscopic, histologic, functional, and laboratory findings, and patient-reported outcome (PRO) measures. The patient-reported outcome (PRO) measures are those that are designed to be self-reported by patients. Commonly used PRO instruments include those that assess symptom severity, health-related quality of life, "general" quality of life, or health status. Regulatory authorities increasingly rely on PRO measures to support labeling claims for drug development. Validated PRO measures for various esophageal diseases are needed in order to unify and standardize the way disease activity is assessed, define clinically meaningful endpoints for use in interventional and observational studies, compare the efficacy/effectiveness of various therapies, and optimize therapeutic algorithms for management of these diseases. This article reviews commonly used PRO instruments designed to assess symptom severity and quality of life in adult patients with EoE and achalasia.
Nature Reviews Gastroenterology & Hepatology, 2016
Journal of pediatric gastroenterology and nutrition, Jan 18, 2016
We evaluated the diagnostic delay (time from first symptoms to diagnosis) in 100 pediatric patien... more We evaluated the diagnostic delay (time from first symptoms to diagnosis) in 100 pediatric patients with Crohn's disease (CD) and 75 patients with ulcerative coltiis (UC). Median [interquartile range] diagnostic delay in CD patients was 4 [2-8] (range 0-82) months compared with 2 [1-7] (range 0-52) months in UC patients (p = 0.003). The time interval from first physician visit to IBD diagnosis was longer in CD patients and UC patients when compared to the time interval from symptom onset to first physician visit (CD: median 3 vs. 1 months, p < 0.001; UC: median 2 vs. 0 months, p < 0.001). No specific risk factors were identified for the length of diagnostic delay. Measures should be taken to reduce diagnostic delay.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 22, 2016
Swiss Medical Weekly, 2012
Eosinophilic Esophagitis (EoE), first described in the early 1990&amp;amp;amp;#39;s, has ... more Eosinophilic Esophagitis (EoE), first described in the early 1990&amp;amp;amp;#39;s, has rapidly evolved as distinctive chronic inflammatory esophageal disease. The diagnosis is based clinically by the presence of symptoms related to an esophageal dysfunction and histologically by an eosinophil-predominant inflammation once other conditions leading to esophageal eosinophilia are excluded. This striking male-prevalent disease has an increasing incidence and prevalence in the westernised countries. Currently, EoE represents the main cause of dysphagia and bolus impaction in adult patients. Despite the fact that EoE often occurs in atopic patients, the value of allergic testing is still under discussion. Topical corticosteroids lead to a rapid improvement of active EoE clinically and histologically; they are therefore regarded as first-line drug therapy. Elimination diets have similar efficacy as topical corticosteroids, but their long-term use is limited by practical issues. Esophageal dilation of EoE-induced strictures can also be effective in improving symptoms, but this therapy has no effect on the underlying inflammation. Neither the diagnostic nor the long-term therapeutic strategies are yet fully defined.
Forschende Komplementarmedizin Und Klassische Naturheilkunde Research in Complementary and Classical Natural Medicine, Jul 1, 2005
Patients with M. Crohn or colitis ulcerosa live with a chronic disease. Pharmaceuticals used in c... more Patients with M. Crohn or colitis ulcerosa live with a chronic disease. Pharmaceuticals used in convention-al medicine have been proven to be effective but can have strong side-effects. Thus, it is no surprise that affected patients are very interested in complementary and alternative medicine (CAM). The aim of our survey was to investigate the use and the application of CAM by patients with M. Crohn and colitis ulcerosa in Switzerland. Out-patients of the gastroenterological centre at the University Hospital Bern and of two gastroenterological private practices in a medium-sized city completed a self-administered questionnaire on CAM. Demographic variables, disease-related data, use of different approaches of complementary medicine, attitudes towards and the use of CAM were asked for. Out of 204 mailed questionnaires 71% (144) could be evaluated, 44% from patients of the University Hospital, 56% from patients of the gastroenterological private practices. CAM was used by 47% of the patients. The most commonly used methods of CAM were: homeopathy, traditional Chinese medicine and acupuncture. 67% of the patients benefitted by CAM in the long run, whereas 10.5% suffered a relapse of their disease during CAM therapies. The main reason for the patients to apply to CAM was to complement conventional treatment. Our survey points out that the studied out-patients have a strong interest in CAM. It is therefore important that clinical research in the various unconventional therapies will be further promoted.
Endoscopy, Feb 1, 2008
Strictures are a frequent complication of eosinophilic esophagitis. The efficacy and safety of to... more Strictures are a frequent complication of eosinophilic esophagitis. The efficacy and safety of topical corticosteroids and of dilation of eosinophilic esophagitis-associated strictures have not yet been thoroughly clarified. We present a retrospective analysis of 10 adult patients with eosinophilic esophagitis who had symptomatic esophageal stenosis that was unresponsive to topical corticosteroids, and who were treated using bougienage. Eight patients had one single stricture, one patient had two, and another had three strictures; mean stricture length was 2.1 cm (range 1 - 6 cm). Bougienage led to prompt symptom relief. Apart from transient postprocedural odynophagia, no severe complications occurred. During the follow-up (mean 6 months; range 2 - 11 months), all patients enjoyed sustained treatment response.
Turkiye Klinikleri Allerji Astım Dergisi, 2004
Journal of Allergy and Clinical Immunology, 2009
European Journal of Gastroenterology Hepatology, Oct 1, 2007
Eosinophilic oesophagitis (EO) is a chronic inflammatory disorder of the oesophagus that is rapid... more Eosinophilic oesophagitis (EO) is a chronic inflammatory disorder of the oesophagus that is rapidly increasing in prevalence. Although systemic and topical corticosteroids are effective in treating EO, some patients develop corticosteroid dependency. Alternative therapeutic approaches that avoid corticosteroids are scarce. To analyse our experience at inducing and maintaining remission with an immunomodulatory therapy in steroid-dependent EO patients. We analysed the clinical and histological response to azathioprine (AZA) and 6-mercaptopurine in three patients with EO (one also with eosinophilic gastroenteritis) and corticosteroid dependency. In all three patients, AZA or 6-mercaptopurine-induced clinical and histological remission that was maintained during the follow-up period (range 3-8 years). Two patients experienced relapses after ceasing AZA therapy. Remission, however, resumed when short-term corticosteroid treatment was followed by AZA. In all the patients, blood eosinophilia disappeared under AZA treatment. Only jumbo biopsies confirmed suspected EO with predominant muscle-layer involvement in one patient. In adult patients with corticosteroid-dependent EO, immunomodulatory treatment with purine analogues is a promising therapeutic approach for inducing and maintaining long-term remission without the need for further corticosteroids. Jumbo forcep biopsies might be needed to confirm a diagnosis of muscle-layer predominant EO.
Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. Th... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your work, please use the accepted author's version for posting to your own website or your institution's repository. You may further deposit the accepted author's version on a funder's repository at a funder's request, provided it is not made publicly available until 12 months after publication.
J Allerg Clin Immunol, 2008
Background: In pilot studies, PillCam COLON capsule endoscopy (PCCE) has been shown feasible and ... more Background: In pilot studies, PillCam COLON capsule endoscopy (PCCE) has been shown feasible and able to demonstrate colon polyps and cancers and has the potential of being performed outside of medical units. An 8-center prospective study with a target of 329 patients is ongoing in Europe. The primary objective is to assess the yield of PCCE in detecting polyps and other pathologies in comparison to traditional colonoscopy. This study reports the first planned interim analysis. Methods: Patients included in this study were known to have (age older than 18 years) or suspected of having (age older than 50 years) colonic disease and were referred for colonoscopy. Patients went through a traditional polyethylene glycol colon preparation and ingested the capsule in the morning. The procedure included prokinetic agents and additional small doses of laxatives. Independent physicians performed capsule imaging analysis and traditional colonoscopy ("gold standard") after excretion. Significant findings were defined as at least one polyp Ն6 mm or Ն3 polyps of any size. Results: Eighty-four patients, with a mean age of 60 (23-84) years, were included and analyzed for this interim analysis. Capsules were expelled within 8 hours postingestion in 91% of patients, and an additional 9% reached the rectosigmoid. Quality of colon preparation in PCCE was evaluated as excellent to good (66%), fair (29%), and poor (6%). Fifty-nine patients (70%) had a polyp of any size, and 38 (45%) had significant findings detected by colonoscopy. The yield of PCCE compared with colonoscopy is shown in . Six polyps were detected only by PCCE. No adverse events related to PCCE were reported.
Journal of Allergy and Clinical Immunology, 2001
Background: Idiopathic eosinophilic esophagitis (IEE) is a chronic-inflammatory disorder of the e... more Background: Idiopathic eosinophilic esophagitis (IEE) is a chronic-inflammatory disorder of the esophagus of unknown origin. The established cornerstone of diagnosis is a dense infiltration of the esophagus with eosinophils, but neither the precise pattern of inflammatory cell infiltration nor the mechanisms that likely contribute to induction and maintenance of the inflammatory response have been described. Objective: The intention of this study was to characterize the esophageal inflammatory infiltrate and the expression of cytokines in the esophagus in this disease. In addition, we searched for immunologic abnormalities of blood leukocytes to exclude major primary hyporeactive and hyperreactive conditions of the immune system. Methods: Infiltration of inflammatory cells in the esophagus, stomach, and duodenum was analyzed by immunohistochemistry through use of mAbs against lineage-associated molecules. Cytokine expression was measured by ELISA and immunohistochemical analysis. Lymphocyte subpopulations in blood were determined by means of flow cytometry. Results: High eosinophil infiltration into the esophageal squamous epithelium was observed in patients with IEE but not in control subjects. Interestingly, increased T-cell and mast cell numbers were also found within the epithelium in these patients. In contrast, the numbers of inflammatory cells were not increased in the stomach and duodenum in patients with IEE, suggesting a specific inflammatory process within the esophagus. Moreover, increased expression of IL-5 and TNF-α was observed in esophageal epithelial biopsy specimens. The distribution of lymphocyte subsets in the peripheral blood and their capacity to generate cytokines did not reflect the changes observed at the inflammatory site. Conclusions: IEE is a selective inflammatory response of the esophagus. T cells, IL-5, eosinophils, and IgE-mediated mechanisms appear to be involved, giving rise to the possibility that allergic reactions might play a role in the pathogenesis of the disease. (J Allergy Clin Immunol 2001;108:954-61.)
J Allerg Clin Immunol, 2002
Background: Idiopathic eosinophilic esophagitis (IEE) is a chronic-inflammatory disorder of the e... more Background: Idiopathic eosinophilic esophagitis (IEE) is a chronic-inflammatory disorder of the esophagus of unknown origin. The established cornerstone of diagnosis is a dense infiltration of the esophagus with eosinophils, but neither the precise pattern of inflammatory cell infiltration nor the mechanisms that likely contribute to induction and maintenance of the inflammatory response have been described. Objective: The intention of this study was to characterize the esophageal inflammatory infiltrate and the expression of cytokines in the esophagus in this disease. In addition, we searched for immunologic abnormalities of blood leukocytes to exclude major primary hyporeactive and hyperreactive conditions of the immune system. Methods: Infiltration of inflammatory cells in the esophagus, stomach, and duodenum was analyzed by immunohistochemistry through use of mAbs against lineage-associated molecules. Cytokine expression was measured by ELISA and immunohistochemical analysis. Lymphocyte subpopulations in blood were determined by means of flow cytometry. Results: High eosinophil infiltration into the esophageal squamous epithelium was observed in patients with IEE but not in control subjects. Interestingly, increased T-cell and mast cell numbers were also found within the epithelium in these patients. In contrast, the numbers of inflammatory cells were not increased in the stomach and duodenum in patients with IEE, suggesting a specific inflammatory process within the esophagus. Moreover, increased expression of IL-5 and TNF-α was observed in esophageal epithelial biopsy specimens. The distribution of lymphocyte subsets in the peripheral blood and their capacity to generate cytokines did not reflect the changes observed at the inflammatory site. Conclusions: IEE is a selective inflammatory response of the esophagus. T cells, IL-5, eosinophils, and IgE-mediated mechanisms appear to be involved, giving rise to the possibility that allergic reactions might play a role in the pathogenesis of the disease. (J Allergy Clin Immunol 2001;108:954-61.)
Der Pathologe, Mar 1, 2013
Eosinophilic esophagitis is characterized by symptoms of esophageal dysfunction and eosinophil-pr... more Eosinophilic esophagitis is characterized by symptoms of esophageal dysfunction and eosinophil-predominant esophageal inflammation. Eosinophilic inflammation in other parts of the gastrointestinal tract is absent and several differential diagnoses for esophageal eosinophilia have to be excluded before diagnosing eosinophilic esophagitis. Most patients are male and have concomitant atopic disorders. Therapeutic options are based on drugs, diet and dilation.
Current Opinion in Gastroenterology, Jun 1, 2009
Eosinophilic esophagitis (EoE) is a relatively new chronic inflammatory disease of the esophagus.... more Eosinophilic esophagitis (EoE) is a relatively new chronic inflammatory disease of the esophagus. Novel aspects in the diagnosis and treatment of EoE are discussed in this review. Development of diagnostic guidelines consisting of symptoms as well as endoscopic and histopathologic criteria has improved the awareness of clinicians and the diagnosing of EoE. The clinically challenging discrimination of EoE from gastroesophageal reflux disease has become more obvious and has evoked the need for more individualized therapy options. Today, most patients with EoE can be treated successfully with topical corticosteroids. However, no convincing alternative treatment strategies exist for corticosteroid-refractory or corticosteroid-dependent patients. Interestingly, a single-nucleotide polymorphism in the eotaxin-3 gene has been linked to increased disease susceptibility for EoE. EoE is an emerging esophageal disease. A better understanding of the pathogenesis of this disorder would improve the clinical recognition and diagnostic ability and ultimately provide patients with more optimal treatment options.
Current Treatment Options in Gastroenterology, 2016
The activity of a particular esophageal disease, such as eosinophilic esophagitis (EoE) or achala... more The activity of a particular esophageal disease, such as eosinophilic esophagitis (EoE) or achalasia, can be evaluated using clinician-reported outcome (ClinRO) measures assessing various endoscopic, histologic, functional, and laboratory findings, and patient-reported outcome (PRO) measures. The patient-reported outcome (PRO) measures are those that are designed to be self-reported by patients. Commonly used PRO instruments include those that assess symptom severity, health-related quality of life, "general" quality of life, or health status. Regulatory authorities increasingly rely on PRO measures to support labeling claims for drug development. Validated PRO measures for various esophageal diseases are needed in order to unify and standardize the way disease activity is assessed, define clinically meaningful endpoints for use in interventional and observational studies, compare the efficacy/effectiveness of various therapies, and optimize therapeutic algorithms for management of these diseases. This article reviews commonly used PRO instruments designed to assess symptom severity and quality of life in adult patients with EoE and achalasia.
Nature Reviews Gastroenterology & Hepatology, 2016
Journal of pediatric gastroenterology and nutrition, Jan 18, 2016
We evaluated the diagnostic delay (time from first symptoms to diagnosis) in 100 pediatric patien... more We evaluated the diagnostic delay (time from first symptoms to diagnosis) in 100 pediatric patients with Crohn's disease (CD) and 75 patients with ulcerative coltiis (UC). Median [interquartile range] diagnostic delay in CD patients was 4 [2-8] (range 0-82) months compared with 2 [1-7] (range 0-52) months in UC patients (p = 0.003). The time interval from first physician visit to IBD diagnosis was longer in CD patients and UC patients when compared to the time interval from symptom onset to first physician visit (CD: median 3 vs. 1 months, p < 0.001; UC: median 2 vs. 0 months, p < 0.001). No specific risk factors were identified for the length of diagnostic delay. Measures should be taken to reduce diagnostic delay.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 22, 2016
Swiss Medical Weekly, 2012
Eosinophilic Esophagitis (EoE), first described in the early 1990&amp;amp;amp;#39;s, has ... more Eosinophilic Esophagitis (EoE), first described in the early 1990&amp;amp;amp;#39;s, has rapidly evolved as distinctive chronic inflammatory esophageal disease. The diagnosis is based clinically by the presence of symptoms related to an esophageal dysfunction and histologically by an eosinophil-predominant inflammation once other conditions leading to esophageal eosinophilia are excluded. This striking male-prevalent disease has an increasing incidence and prevalence in the westernised countries. Currently, EoE represents the main cause of dysphagia and bolus impaction in adult patients. Despite the fact that EoE often occurs in atopic patients, the value of allergic testing is still under discussion. Topical corticosteroids lead to a rapid improvement of active EoE clinically and histologically; they are therefore regarded as first-line drug therapy. Elimination diets have similar efficacy as topical corticosteroids, but their long-term use is limited by practical issues. Esophageal dilation of EoE-induced strictures can also be effective in improving symptoms, but this therapy has no effect on the underlying inflammation. Neither the diagnostic nor the long-term therapeutic strategies are yet fully defined.
Forschende Komplementarmedizin Und Klassische Naturheilkunde Research in Complementary and Classical Natural Medicine, Jul 1, 2005
Patients with M. Crohn or colitis ulcerosa live with a chronic disease. Pharmaceuticals used in c... more Patients with M. Crohn or colitis ulcerosa live with a chronic disease. Pharmaceuticals used in convention-al medicine have been proven to be effective but can have strong side-effects. Thus, it is no surprise that affected patients are very interested in complementary and alternative medicine (CAM). The aim of our survey was to investigate the use and the application of CAM by patients with M. Crohn and colitis ulcerosa in Switzerland. Out-patients of the gastroenterological centre at the University Hospital Bern and of two gastroenterological private practices in a medium-sized city completed a self-administered questionnaire on CAM. Demographic variables, disease-related data, use of different approaches of complementary medicine, attitudes towards and the use of CAM were asked for. Out of 204 mailed questionnaires 71% (144) could be evaluated, 44% from patients of the University Hospital, 56% from patients of the gastroenterological private practices. CAM was used by 47% of the patients. The most commonly used methods of CAM were: homeopathy, traditional Chinese medicine and acupuncture. 67% of the patients benefitted by CAM in the long run, whereas 10.5% suffered a relapse of their disease during CAM therapies. The main reason for the patients to apply to CAM was to complement conventional treatment. Our survey points out that the studied out-patients have a strong interest in CAM. It is therefore important that clinical research in the various unconventional therapies will be further promoted.