Alexander, J.A.

SummaryBackgroundProton pump inhibitors (PPI) are inconsistently associated with osteoporotic fractures. Barrett's oesophagus (BO) patients are treated with high PPI doses for prolonged periods, but there are limited data on the incidence of osteoporosis and fractures in this group pf patients.AimTo estimate the incidence of (and risk factors for) low bone mass (osteoporosis and/or osteopenia) related fractures in a population‐based BO cohort.MethodsAll subjects with BO and a diagnosis of osteoporosis and fractures were identified using Rochester Epidemiology Project resources. The incidence rates of all and osteoporotic fractures in these subjects were compared to an age‐ and gender similar population in Olmsted County to determine standardised incidence ratios (SIR). Predictors were assessed using Cox proportional hazards models.ResultsFive hundred and twenty‐one patients were included (median [IQR] age 61 [52, 72] years; 398 [76%] men) of whom 113 (21.7%) had fractures, and 46 (8.8%) had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that of an age‐ and gender‐matched population (SIR 1.09; 95% CI 0.92‐1.29: SIR 1.05; 95% CI 0.85‐1.29). PPI use, dose or duration of use was not associated with osteoporotic fracture risk (HR 0.87; 95% CI 0.12‐6.39). Independent risk factors for osteoporotic fractures included older age, female gender and higher co‐morbidity index.ConclusionsThe incidence of osteoporotic fractures was not increased in BO patients compared to the general population. In addition, PPI use was not associated with increased fracture risk regardless of the duration of therapy or dose.

SummaryBackgroundOesophageal lichen planus is an idiopathic inflammatory disorder characterized by significant oesophageal stricturing. Oesophageal lichen planus is a rare, difficult to diagnose, and likely an under recognized disease. As a result, there is no standardized approach to therapy and treatment strategies vary.AimTo examine the utility of topical steroid therapy (fluticasone or budesonide) in the management of oesophageal lichen planus.MethodsA retrospective chart review was conducted of patients diagnosed with oesophageal lichen planus who underwent baseline and follow up endoscopy pre and post topical steroid therapy between 1995 and 2016 at Mayo Clinic, Rochester MN. Average time between upper GI endoscopy was 3.2 months (0.7–11.7). Swallowed steroid preparations included fluticasone 880 μg twice daily or budesonide 3 mg twice daily. Patients were reviewed for symptomatic response to therapy using the Dakkak‐Bennett dysphagia score (0–4, no dysphagia to total aphagia). Pre‐ and post‐endoscopic findings were assessed. Additional baseline demographic, endoscopic, and histologic data were also obtained.ResultsWe identified 40 patients who met the inclusion criteria. A significant reduction in median dysphagia score from 1 (0–4) to 0 (0–3) after steroid therapy (P < 0.001) was noted. 62% of patients reported resolution of their dysphagia after receiving topical corticosteroids. 72.5% had an endoscopic response to steroid therapy.ConclusionTopical swallowed budesonide or fluticasone appear to effective treatment for oesophageal lichen planus.

Summary Background To date there have been no clear features that aid in differentiating patients with eosinophilic oesophagitis (EoE) from PPI ‐responsive oesophageal eosinophilia ( PPI ‐ REE ). However, barium swallow roentgenography is a more sensitive and specific measure to detect subtle fibrostenotic remodeling changes present in EoE. We aim to characterise any clinical, endoscopic, histiological or barium roentgenographic differences between EoE and PPI ‐ REE . Aim To characterise any clinical, endoscopic, histiological or barium roentgenographic differences between EoE and PPI ‐ REE . Methods We performed a retrospective cohort analysis on data collected from a tertiary referral centre population from 2010 to 2015. Data from 66 patients with EoE and 28 patients with PPI ‐ REE were analysed. Cases were adults who met consensus guidelines for EOE , and had a barium swallow study within 6 months of the index endoscopy. Clinical, endoscopic, histiological and barium swallow findings were collected. Results Patients with EoE reported similar characteristics as PPI ‐ REE patients, except EoE patients were younger (35.6 vs. 46.6 years; P = 0.011), had earlier symptom onset (29.0 vs. 38.0 years; P = 0.026), and smaller oesophageal diameters on barium swallow (19.5 mm vs. 20; P = 0.042). Patients with EoE were more likely to have distal strictures (EoE 77% vs. 25%; P = 0.02) and, importantly, a greater likelihood of small calibre oesophagus (51.5% vs. 17.9%; P = 0.002). Moreover, EoE patients had a higher probability of developing small calibre oesophagus after 20 years of symptoms (72.3% vs. 30.2%; P = 0.074) compared to PPI ‐ REE patients. Conclusions When compared with eosinophilic oesophagitis, PPI ‐ REE patients demonstrate findings that suggest PPI‐responsive oesophageal eosinophilia to be a later onset, less aggressive form of oesophageal stricturing disease than eosinophilic oesophagitis.