Distribution and variability of esophageal eosinophilia in patients undergoing upper endoscopy

The variability of eosinophilic infiltrates in eosinophilic esophagitis is not well described. This study aimed to determine the distribution of esophageal eosinophilia and the utility of histologic cut-points for eosinophilic esophagitis diagnosis in subjects undergoing endoscopy. We performed a prospective study of adults undergoing outpatient endoscopy. Research protocol esophageal biopsies were obtained from all subjects. Incident cases of eosinophilic esophagitis were diagnosed per consensus guidelines. Biopsies were interpreted following a validated protocol, and maximum eosinophil counts (eosinophils per high-power field; eos/hpf) were determined. Histologic analyses were performed on a per-patient, per-biopsy, and per-hpf basis. There were 213 patients, yielding 923 esophageal biopsies with 4588 hpfs. Overall, 48 patients (23%), 165 biopsy fragments (18%), and 449 hpfs (10%) had ≥ 15 eos/hpf; most subjects had no or low levels of eosinophils. In the eosinophilic esophagitis cases, 119 biopsy fragments (63%) and 332 hpfs (36%) had ≥ 15 eos/hpf. There was a mean 104-fold difference between the lowest and highest hpf eosinophil count for the eosinophilic esophagitis patients; 85% of the biopsies from eosinophilic esophagitis cases also had at least one hpf with < 15 eos/hpf. The cut-point of 15 eos/hpf had a sensitivity of 100% and specificity of 96% for diagnosis of eosinophilic esophagitis. In conclusion, most patients have little to no esophageal eosinophilia. In patients with eosinophilic esophagitis, there was marked variability in the eosinophil counts by biopsy and by hpf within a given biopsy. Additionally, the 15 eos/hpf cut-point was highly sensitive and specific for eosinophilic esophagitis. Multiple esophageal biopsies from different locations should be obtained to optimize eosinophilic esophagitis diagnosis

Association Between Body Mass Index and Clinical and Endoscopic Features of Eosinophilic Esophagitis

Because eosinophilic esophagitis (EoE) causes dysphagia, esophageal narrowing, and strictures, it could result in low body mass index (BMI), but there are few data assessing this

Markers of Eosinophilic Inflammation for Diagnosis of Eosinophilic Esophagitis and Proton Pump Inhibitor–Responsive Esophageal Eosinophilia: A Prospective Study

Distinguishing between eosinophilic esophagitis (EoE), gastroesophageal reflux disease (GERD), and proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is challenging. We assessed whether immunohistochemical analysis of esophageal tissues for major basic protein (MBP), eotaxin3, and tryptase can be used in diagnosis of EoE and to differentiate EoE from PPI-REE

Utility of a Noninvasive Serum Biomarker Panel for Diagnosis and Monitoring of Eosinophilic Esophagitis: A Prospective Study

Non-invasive biomarkers would be valuable for diagnosis and monitoring of eosinophilic esophagitis (EoE). The aim of this study was to determine the utility of a panel of serum biomarkers for the diagnosis and management of EoE

A Clinical Prediction Tool Identifies Cases of Eosinophilic Esophagitis Without Endoscopic Biopsy: A Prospective Study

Eosinophilic esophagitis (EoE) is difficult to distinguish from gastroesophageal reflux (GERD) and other causes of dysphagia. We assessed the utility of a set of clinical and endoscopic features for predicting EoE without obtaining esophageal biopsies

Climate fluctuations of tropical coupled system: The role of ocean dynamics

The tropical oceans have long been recognized as the most important region for large-scale ocean–atmosphere interactions, giving rise to coupled climate variations on several time scales. During the Tropical Ocean Global Atmosphere (TOGA) decade, the focus of much tropical ocean research was on understanding El Niño–related processes and on development of tropical ocean models capable of simulating and predicting El Niño. These studies led to an appreciation of the vital role the ocean plays in providing the memory for predicting El Niño and thus making seasonal climate prediction feasible. With the end of TOGA and the beginning of Climate Variability and Prediction (CLIVAR), the scope of climate variability and predictability studies has expanded from the tropical Pacific and ENSO-centric basis to the global domain. In this paper the progress that has been made in tropical ocean climate studies during the early years of CLIVAR is discussed. The discussion is divided geographically into three tropical ocean basins with an emphasis on the dynamical processes that are most relevant to the coupling between the atmosphere and oceans. For the tropical Pacific, the continuing effort to improve understanding of large- and small-scale dynamics for the purpose of extending the skill of ENSO prediction is assessed. This paper then goes beyond the time and space scales of El Niño and discusses recent research activities on the fundamental issue of the processes maintaining the tropical thermocline. This includes the study of subtropical cells (STCs) and ventilated thermocline processes, which are potentially important to the understanding of the low-frequency modulation of El Niño. For the tropical Atlantic, the dominant oceanic processes that interact with regional atmospheric feedbacks are examined as well as the remote influence from both the Pacific El Niño and extratropical climate fluctuations giving rise to multiple patterns of variability distinguished by season and location. The potential impact of Atlantic thermohaline circulation on tropical Atlantic variability (TAV) is also discussed. For the tropical Indian Ocean, local and remote mechanisms governing low-frequency sea surface temperature variations are examined. After reviewing the recent rapid progress in the understanding of coupled dynamics in the region, this study focuses on the active role of ocean dynamics in a seasonally locked east–west internal mode of variability, known as the Indian Ocean dipole (IOD). Influences of the IOD on climatic conditions in Asia, Australia, East Africa, and Europe are discussed. While the attempt throughout is to give a comprehensive overview of what is known about the role of the tropical oceans in climate, the fact of the matter is that much remains to be understood and explained. The complex nature of the tropical coupled phenomena and the interaction among them argue strongly for coordinated and sustained observations, as well as additional careful modeling investigations in order to further advance the current understanding of the role of tropical oceans in climate

FGF21-Mediated Improvements in Glucose Clearance Require Uncoupling Protein 1

Fibroblast growth factor 21 (FGF21)-mediated weight loss and improvements in glucose metabolism correlate with increased uncoupling protein 1 (Ucp1) levels in adipose tissues, suggesting that UCP1-dependent thermogenesis may drive FGF21 action. It was reported that FGF21 is equally effective at reducing body weight and improving glucose homeostasis without UCP1. We find while FGF21 can lower body weight in both wild-type and Ucp1 knockout mice, rapid clearance of glucose by FGF21 is defective in the absence of UCP1. Furthermore, in obese wild-type mice there is a fall in brown adipose tissue (BAT) temperature during glucose excursion, and FGF21 improves glucose clearance while preventing the fall in BAT temperature. In Ucp1 knockout mice, the fall in BAT temperature during glucose excursion and FGF21-mediated changes in BAT temperature are lost. We conclude FGF21-mediated improvements in clearance of a glucose challenge require UCP1 and evoke UCP1-dependent thermogenesis as a method to increase glucose disposal