Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy and Persistence of the Fibrostenotic Phenotype

Esophageal dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal dilation in a large cohort of EoE cases and determine the frequency and predictors of requiring multiple dilations

The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis

Some patients with eosinophilic esophagitis (EoE) have an extremely narrowed esophagus, but the characteristics of this group have not been extensively described. We aimed to characterize the narrow-caliber phenotype of EoE, determine associated risk factors, and identify differences in treatment response in this sub-group of patients

Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy

Although peanut oral immunotherapy (OIT) has been conclusively shown to cause desensitization, it is currently unknown whether clinical protection persists after stopping therapy

Chinese Principal Perceptions on the American School Leadership Standards: The Disparity among Leadership Dimensions

The purpose of this study was to examine the perceptions of Chinese school principals on the importance of American Educational Leadership Program Standards. Seventy three principals from a county in Guangdong, China completed the Principal Leadership Standards Questionnaire. The results of the study revealed that the Chinese principals perceived the majority of American leadership standards to be either important or very important in school administration. Perception differences among the leadership dimensions were significant. The principal leadership standards in the management of school organization and school instruction were perceived to be significantly more important than the leadership dimensions of school vision and collaborative partnership. The results of the study contribute to the development of school leadership training programs in China. Recommendations were made in using the framework of American leadership standards in China for the development and re-development of university programs and professional trainings in school leadership

The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis

BACKGROUND AND AIMS: Some patients with eosinophilic esophagitis (EoE) have an extremely narrowed esophagus, but the characteristics of this group have not been extensively described. We aimed to characterize the narrow-caliber phenotype of EoE, determine associated risk factors, and identify differences in treatment response in this sub-group of patients. METHODS: This retrospective cohort study from 2001 to 2014 included subjects with a new diagnosis of EoE per consensus guidelines. Demographic, endoscopic, histologic, and treatment response data were extracted from medical records. An “extreme narrow-caliber esophagus” was defined when the neonatal endoscope was required to traverse the esophagus due to inability to pass an adult endoscope. Cases with and without the extreme narrow-caliber esophagus were compared. Multivariable logistical regression was performed to assess treatment outcomes. RESULTS: Of 513 patients with EoE, 46 (9%) had an extreme narrow-caliber esophagus. These cases were older (33 vs 22 years; p<0.01), had longer symptom duration (11 vs 3 years; p<0.01), more dysphagia (98% vs 66%; p<0.01), and food impactions (53% vs 31%; p<0.01). Dilation was more common with extreme narrowing (69% vs 17%; p<0.01). Narrow-caliber patients were more refractory to steroid treatment, with lower symptom (56% vs 85%), endoscopic (52% vs 76%), and histologic (33% vs 63%) responses (p<0.01 for all), and these differences persisted after multivariate analysis. CONCLUSION: The extreme narrow-caliber esophagus is a more treatment-resistant sub-phenotype of EoE and is characterized by longer symptom duration and requirement for multiple dilations. Recognition at diagnosis of EoE can provide important prognostic information

Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy, and Persistence of the Fibrostenotic Phenotype

OBJECTIVES: Esophageal dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal dilation in a large cohort of EoE cases and determine the frequency and predictors of requiring multiple dilations. METHODS: We conducted a retrospective cohort study in the University of North Carolina EoE clinicopathological database from 2002-2014. Included subjects met consensus diagnostic criteria for EoE. Clinical, endoscopic, and histologic features were extracted, as were dilation characteristics (dilator type, change in esophageal caliber, total number of dilations) and complications. Patients with EoE who had undergone dilation were compared to those who did not and also stratified by whether they required single or multiple dilations. RESULTS: Of 509 EoE patients, 164 were dilated a total of 486 times. Those who underwent dilation had a longer duration of symptoms prior to diagnosis (11.1 vs. 5.4 yrs, p<0.001). 95 patients (58%) required >1 dilation (417 dilations total, mean of 4.4 ± 4.3 per patient). The only predictor of requiring multiple dilations was a smaller baseline esophageal diameter. Dilation was tolerated well, with no major bleeds, perforations, or deaths. The overall complication rate was 5%, primarily due to post-procedural pain. Of 164 individuals dilated, a majority (58%, or 95/164) required a second dilation. Of these individuals, 75% required dilation within 1 year. CONCLUSIONS: Dilation in EoE is well-tolerated, with a very low risk of serious complications. Patients with long-standing symptoms prior to diagnosis are likely to require dilation. More than half of those dilated will require multiple dilations, often needing a second procedure within one year. These findings can be used to counsel patients with fibrostenotic complications of EoE