Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presenta...Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/10s in children and 2.5/10s in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a "feline" or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimal contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate (〉20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors, or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign, albeit inconvenient, course. With increasing recognition, this entity is taking its place as an established cause of solid food dysphagia.展开更多
Objective: We observe the curative effect, median survival time, time to progression, quality of life and adverse effect of patients with advanced refractory non-small cell lung cancer (NSCLC) after gefitinib (Ire...Objective: We observe the curative effect, median survival time, time to progression, quality of life and adverse effect of patients with advanced refractory non-small cell lung cancer (NSCLC) after gefitinib (Iressa) treatment. Methods: Forty-one patients with grade Ⅲb to Ⅳ NSCLC previously treated with two chemotherapy including 85.4% of patients after second line therapy were chosen. The regimen was oral intake of gefitinib 250 mg once daily until the disease progression or toxic reaction has become intolerable. The patients were required to receive tumor evaluation before the treatment, one month, two month and every three months after Iressa administration. Results: All of 41 patients were evaluable for therapeutic effect. Without complete regression being observed, partial response rate (PR), stable disease (SD) and progression of disease (PD) were 43.9% (18/41), 34.1% (14/41) and 22.1% (9/41), respectively. The overall response rate was 43.9% (18141) and disease control rate (PR + SD) was 78% (32/41). The response rate in male was 42.1%, while it in female was 45.5% (P 〉 0.05). Twenty-two of them (53.7%, 22/41) were still alive with 10.1 months of MST when the follow-up ended in November 2006. TTP and MST of patients who died was 2.7 and 5.0 months, respectively. The rate of symptom improvement was 78% of all patients with 13 months of MST of PR patients. The Karnofsky enhanced 20 + 5 after 28 days treatment without 3-4 degree of reactive toxicity. Conclusion: Iressa has significant antitumor activity in advanced NSCLC patients who have previously failed in second or third line chemotherapy. Iressa is effective and safe for patients with poor performance status.展开更多
Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(...Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and CDI.Methods:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch Disorders.The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses.Results:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch surgery.After a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions each.Within the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via enemas.All patients tested negative on C.difficile polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity Index.During the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with FMT.Conclusions:FMT appeared to be effective in eradication of CDI in patients with ileal pouches.However,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.展开更多
文摘Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/10s in children and 2.5/10s in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a "feline" or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimal contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate (〉20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors, or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign, albeit inconvenient, course. With increasing recognition, this entity is taking its place as an established cause of solid food dysphagia.
文摘Objective: We observe the curative effect, median survival time, time to progression, quality of life and adverse effect of patients with advanced refractory non-small cell lung cancer (NSCLC) after gefitinib (Iressa) treatment. Methods: Forty-one patients with grade Ⅲb to Ⅳ NSCLC previously treated with two chemotherapy including 85.4% of patients after second line therapy were chosen. The regimen was oral intake of gefitinib 250 mg once daily until the disease progression or toxic reaction has become intolerable. The patients were required to receive tumor evaluation before the treatment, one month, two month and every three months after Iressa administration. Results: All of 41 patients were evaluable for therapeutic effect. Without complete regression being observed, partial response rate (PR), stable disease (SD) and progression of disease (PD) were 43.9% (18/41), 34.1% (14/41) and 22.1% (9/41), respectively. The overall response rate was 43.9% (18141) and disease control rate (PR + SD) was 78% (32/41). The response rate in male was 42.1%, while it in female was 45.5% (P 〉 0.05). Twenty-two of them (53.7%, 22/41) were still alive with 10.1 months of MST when the follow-up ended in November 2006. TTP and MST of patients who died was 2.7 and 5.0 months, respectively. The rate of symptom improvement was 78% of all patients with 13 months of MST of PR patients. The Karnofsky enhanced 20 + 5 after 28 days treatment without 3-4 degree of reactive toxicity. Conclusion: Iressa has significant antitumor activity in advanced NSCLC patients who have previously failed in second or third line chemotherapy. Iressa is effective and safe for patients with poor performance status.
文摘Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and CDI.Methods:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch Disorders.The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses.Results:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch surgery.After a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions each.Within the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via enemas.All patients tested negative on C.difficile polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity Index.During the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with FMT.Conclusions:FMT appeared to be effective in eradication of CDI in patients with ileal pouches.However,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.