Center for Esophageal Diseases and Swallowing

Lake Norman of Catawba, NC, United States

Center for Esophageal Diseases and Swallowing

Lake Norman of Catawba, NC, United States

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Kim H.P.,Center for Esophageal Diseases and Swallowing | Ringel-Kulka T.,University of North Carolina at Chapel Hill | Dellon E.S.,Center for Esophageal Diseases and Swallowing
Journal of Pediatric Gastroenterology and Nutrition | Year: 2013

OBJECTIVES: Few etiologic studies of eosinophilic esophagitis (EoE) have been conducted. Early life exposures have been shown to predispose to other allergic disease, but their role has not been assessed in EoE. The present study sought to explore early life exposures as possible risk factors for developing EoE in the pediatric population. METHODS: This was a 2-phase case-control study conducted at the University of North Carolina. The first phase consisted of survey development for early life exposures via cognitive interview. In the second phase, a telephone-based questionnaire was administered to cases with EoE (n=31) and 2 sets of controls, patients with gastroesophageal reflux disease, and siblings of nonsyndromic cleft lip/palate patients (n=26 in each). Different controls were explored to identify controls reflective of the source population of the cases. Siblings of cleft lip/palate patients were identified as the more suitable control population. Odds ratios were calculated to evaluate the association between early life exposures and the development of pediatric EoE. RESULTS: Early life exposures were associated with increased odds of developing pediatric-onset EoE. Antibiotic use in infancy was associated with 6 times the odds of having EoE (95% confidence interval 1.7-20.8). Cesarean delivery, preterm birth, and formula-only or mixed (infant formula and breast milk) feeding also have trends toward increased odds for developing EoE. CONCLUSIONS: A number of early life exposures may be associated with the development of EoE. These are potentially modifiable risk factors that if confirmed would have implications for improved understanding of EoE pathogenesis and disease prevention. Copyright © 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Jensen E.T.,Center for Esophageal Diseases and Swallowing | Martin C.F.,Center for Gastrointestinal Biology and Disease | Kappelman M.D.,University of North Carolina at Chapel Hill | Dellon E.S.,Center for Esophageal Diseases and Swallowing
Journal of Pediatric Gastroenterology and Nutrition | Year: 2016

Objectives: Eosinophilic esophagitis (EoE) is becoming increasingly more common, but the prevalence of other eosinophilic gastrointestinal disorders (EGIDs) is unknown. Our objective was to estimate the prevalence of eosinophilic gastritis, gastroenteritis, and colitis in the United States. Methods: We used the IMS Health LifeLink PharMetrics Plus Claims Database, data representative of a US national commercially insured population containing medical and pharmaceutical claims for >75 million individuals. We restricted our sample to patients ages 0 to 64 with continuous enrollment between July 1, 2009, and June 30, 2011. We identified patients with eosinophilic gastritis, gastroenteritis, and colitis as defined by ≥1 instance of the International Classification of Diseases, Ninth Revision codes 535.70, 558.41, and 558.42, respectively. Wecalculated the prevalence of the codes in the database and then standardized the estimates to the US population by age and sex. © 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Jones P.D.,Center for Esophageal Diseases and Swallowing | Jones P.D.,Center for Gastrointestinal Biology and Disease | Moll S.,University of North Carolina at Chapel Hill | Dellon E.S.,Center for Esophageal Diseases and Swallowing | Dellon E.S.,Center for Gastrointestinal Biology and Disease
Case Reports in Gastroenterology | Year: 2013

Eosinophilic esophagitis is a chronic immune-mediated disease characterized by infiltration of the esophageal mucosa with eosinophils and concomitant esophageal dysfunction. Though there are well-described associations between certain chronic inflammatory conditions and venous thromboembolism, there have been no reports of venous thromboembolism occurring in eosinophilic esophagitis. We report the case of a 33-year-old man with severe eosinophilic esophagitis resulting in recurrent esophageal strictures who was unresponsive to oral viscous budesonide therapy, and who developed an isolated pulmonary embolism in the absence of risk factors for venous thromboembolism. We then discuss potential mechanisms for venous thromboembolism in eosinophilic esophagitis, such as inflammation-mediated hypercoagulability, hypereosinophilia, and immunoglobulin E-mediated platelet activation. © 2013 S. Karger AG, Basel.


Dellon E.S.,Center for Esophageal Diseases and Swallowing | Cullen N.R.,Center for Esophageal Diseases and Swallowing | Madanick R.D.,Center for Esophageal Diseases and Swallowing | Buckmire R.A.,Center for Esophageal Diseases and Swallowing | And 4 more authors.
Gastrointestinal Endoscopy | Year: 2010

Background: Treatment of head, neck, and esophageal cancers with radiation therapy can lead to esophageal strictures. In some cases, these can progress to complete esophageal obstruction, precluding typical antegrade endoscopic dilation. Objective: The aim of this study was to review our experience with a combined antegrade/retrograde technique for dilation of complete esophageal strictures. Design: Case series. Setting: Tertiary-care referral center. Patients: Twelve patients with complete esophageal radiation-induced strictures. Interventions: In collaboration with otolaryngologists who performed direct antegrade esophagoscopy, retrograde endoscopy via gastrostomy was simultaneously performed. While visualizing the stricture from both sides and transilluminating, it was recannulated with use of a biliary or spring-tipped guidewire, and then dilated. Main Outcome Measurements: Dilation method, complications, and postdilation oral intake. Results: Combined antegrade and retrograde dilation was technically possible in 10 of the 12 patients (83%). Two cases were unsuccessful due to an inability to achieve transillumination. The only significant complication was a contained esophageal perforation that was managed nonoperatively. The mean number of repeat dilations was 7 (range, 1-22); none were complicated by perforation. Esophageal patency allowing at least some oral intake and tolerance of secretions was ultimately successful in 8 patients (67%). Limitations: Retrospective, single center. Conclusions: A combined antegrade/retrograde approach for dilation of complete esophageal radiation-induced strictures in collaboration with colleagues from otolaryngology is a viable treatment option. The procedure is technically feasible, effective, and well tolerated, although there may be an increased risk of esophageal perforation. This strategy may obviate a more invasive surgical approach. © 2010 American Society for Gastrointestinal Endoscopy.


Dellon E.S.,Center for Esophageal Diseases and Swallowing
Gastroenterology Clinics of North America | Year: 2013

Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition whereby infiltration of eosinophils into the esophageal mucosa leads to symptoms of esophageal dysfunction. EoE is encountered in a substantial proportion of patients undergoing diagnostic upper endoscopy. This review discusses the clinical, endoscopic, and histologic features of EoE and presents the most recent guidelines for its diagnosis. Selected diagnostic dilemmas are described, including distinguishing EoE from gastroesophageal reflux disease and addressing the newly recognized clinical entity of proton-pump inhibitor-responsive esophageal eosinophilia. Also highlighted is evidence to support both pharmacologic and nonpharmacologic treatments, including topical corticosteroids, dietary elimination therapy, and endoscopic dilation. © 2013 Elsevier Inc.


Dellon E.S.,Center for Esophageal Diseases and Swallowing | Dellon E.S.,University of North Carolina at Chapel Hill
Digestive Diseases | Year: 2014

Eosinophilic esophagitis (EoE) is currently defined as an immune-mediated chronic esophageal disorder that is diagnosed using both clinical and pathologic information. A series of consensus diagnostic guidelines for EoE have brought a measure of consistency to the field, but in practice the diagnosis of EoE can be challenging. Typical clinical symptoms of EoE, including dysphagia, heartburn, and chest pain, can overlap with gastroesophageal reflux disease, which itself is a common indication for performing endoscopic evaluation. The endoscopic findings of EoE, such as esophageal rings, strictures, linear furrows, and white exudates, are not specific. Esophageal eosinophilia, the histologic hallmark of EoE, is also not pathognomonic and can be seen in a range of conditions. Further complicating the diagnosis of EoE is the newly recognized entity of proton pump inhibitor-responsive esophageal eosinophilia, a condition that must be excluded prior to confirming a diagnosis of EoE. This paper will review the current diagnostic criteria for EoE and discuss multiple clinical, endoscopic, and histologic pitfalls in making the diagnosis of EoE. © 2014 S. Karger AG, Basel.

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