A Brazilian experience of the self transglutaminase-based test for celiac disease case finding and diet monitoring

AIM： To evaluate the effectiveness of a rapid and easy fingertip whole blood point-of-care test for celiac disease （CD） case finding and diet monitoring. METHODS： Three hundred individuals, 206 females （68.7%） and 94 males （31.3%）, were submitted to a rapid and easy immunoglobulin-A-dass fingertip whole blood point-of-care test in the doctor＇s office in order to make immediate clinical decisions： 13 healthy controls, 6 with CD suspicion, 46 treated celiacs, 84 relatives of the celiac patients, 69 patients with dyspepsia, 64 with irritable bowel syndrome （IBS）, 8 with Crohn＇s disease and 9 with other causes of diarrhea. RESULTS： Upper gastrointestinal endoscopy with duodenal biopsies was performed in patients with CD suspicion and in individuals with positive test outcome： in 83.3% （5/6） of the patients with CD suspicion, in 100% of the patients that admitted gluten-free diet transgressions （6/6）, in 3.8% of first-degree relatives （3/79） and in 2.9% of patients with dyspepsia （2/69）. In all these individuals duodenal biopsies confirmed CD （Marsh＇s histological classification）. The studied test showed good correlation with serologic antibodies, endoscopic and histological findings.CONCLUSION： The point-of-care test was as reliable as conventional serological tests in detecting CD cases and in CD diet monitoring.

A Novel Therapy of Eosinophilic Esophagitis-Treatment of Eosinophilic Esophagitis Using a Single Dose of Intramuscular Corticosteroid and Proton Pump Inhibitor

Background： Ee （Eosinophilic esophagitis） is an inflammatory condition characterized by a dense eosinophilic infiltrate in the esophageal epithelium. Its pathophysiology mimics that of allergic esophagitis, and evolves clinically as a chronic disease with periods of exacerbation. Symptoms and endoscopic findings are usually non-specific and similar to those of other esophageal illnesses. The mainstay of treatment of Ee is with corticosteroids and/or specific diets, which have been shown to cause symptom remission and histological improvement. Aim： The objective of this study was to demonstrate the efficacy of a novel and promising treatment protocol for Ee. Materials and methods： We prospectively evaluated 24 patients with Ee over two years. Patients were treated with a single intramuscular injection of betamethasone sodium phosphate associated with betamethasone dipropionate and a PPI （proton pump inhibitor） （rabeprazole 20 mg PO）. After 4 weeks of treatment, patients underwent endoscopy and biopsy. We evaluated patients＇ clinical response as well as the results of endoscopic and histological examinations. Results： After 4 weeks of treatment, all patients （100%） are reported significant clinical improvement, which was corroborated by the findings on endoscopy and histology. There were no complications or adverse reactions. Conclusions： In this cohort of patients with eosinophilic esophagitis, treatment with a single intramuscular dose of corticosteroids led to complete remission of symptoms and improvement in endoscopic and histological findings.

Endoscopic Classification of Esophagic Eosinophilia

Introduction： EoE （eosinophilic esophagitis） is an inflammatory condition characterized by a dense eosinophilic infiltrate in the esophageal epithelium. In Brazil, it remains a poorly diagnosed disease due to the lack of interaction between the clinician, the endoscopist, and the pathologist. The diagnosis is performed by histological study of esophageal biopsies, with at least fifteen eosinophils per high-power field （EOS/HPF）. Some doubts remain with respect to patients with a clinical picture and symptoms compatible with the disease （EoE）, but who have a lower number of eosinophils than established. The main objective of this study was to create an endoscopic classification for EsEo （esophageal eosinophilia）, which pointed the way to the endoscopist towards the diagnosis. Methods： This study was a prospective, two-year study, at a gastrointestinal endoscopy center where all patients with endoscopic symptoms and/or endoscopic findings suggestive of EsEo were biopsied for histological examination of EOS/HPF. After the study and compilation of the results, a retrospective study was performed, based on a review of electronic medical records, where the same diagnosis was searched, although at a period when this classification was not adopted. Results： A total of 4,251 endoscopies were performed between September 2011 and September 2013. Two biopsies were performed, aimed at lesions, in 133 patients with clinical picture or imaging suggestive of EsEo. Eosinophils were found in 55 patients, corresponding to an incidence of 1.29% of the total population studied and 41.35% of the suspected cases of the disease. EoE was diagnosed in 24 patients during the period of this study. In the two-year retrospective study, only two cases of EoE were found. Conclusions： The results of this study demonstrate that the endoscopic standardization of esophageal lesions, suggestive of eosinophilia, in this case by classification, alerts the endoscopist for the diagnosis of EoE, prompting him to perform targeted biopsies. Further, it was observed that two samples of esophageal tissue were sufficient for the diagnosis. The relationship between the clinical picture, endoscopy, and histology was not evident in this study.