Anne Lund Krarup

Introduction: Eosinophilic esophagitis (EoE) has evolved from a rare condition to the leading cause of dysphagia and food impaction. This document (Part 1) provides an updated evidence‐based framework for the definition, epidemiology, natural history, and diagnosis of EoE in children and adults, updating the 2017 European evidence‐based guidelines. Methods: A panel of 32 experts from EUREOS, EAACI, ESPGHAN, and ESP developed these guidelines. Comprehensive literature searches were conducted (PubMed, Scopus, Embase, and Google Scholar) using the PICO framework. The GRADE methodology was applied to assess the certainty of evidence and strength of recommendations, while consensus was established via the Delphi method, requiring a minimum agreement threshold of 80%. Results: These guidelines characterize EoE as a heterogeneous condition driven by type 2 inflammation, with natural history influenced by diverse phenotypes and progression risks. EoE burden has risen sharply, with an annual incidence exceeding 10/100,000 and a pooled prevalence over 60/100,000, surpassing 160/100,000 in some regions. Diagnosis requires both symptoms of esophageal dysfunction and ≥ 15 eosinophils/hpf in esophageal mucosa, following the exclusion of alternative causes. EoE is clearly distinguished from asymptomatic esophageal eosinophilia. Key diagnostic recommendations include obtaining at least six biopsies from at least two esophageal levels, as endoscopic appearance alone lacks sufficient sensitivity. Gastric or duodenal biopsies are no longer mandatory unless driven by specific symptoms or endoscopic abnormalities at any point. Conclusions: These guidelines provide a robust clinical framework that reflects the increasing global prevalence of EoE and standardizes diagnostic criteria across all age groups to improve patient management.

Background: Endoscopy with histopathological assessment of esophageal biopsies is the cornerstone for the diagnosis and phenotypic characterization of eosinophilic esophagitis (EoE). Objective: To evaluate temporal trends in endoscopic assessment and biopsy sampling practices for EoE in a large European cohort and their association with temporal trends in diagnostic delay (DD). Methods: A cross‐sectional analysis was conducted using multicenter data from the EoE CONNECT registry. Endoscopic findings and biopsy data at diagnosis were analyzed. Temporal trends in biopsy strategies, EREFS implementation, and DD were assessed. Diagnostic sensitivity of individual esophageal segments and their combinations was evaluated in patients undergoing multi‐segment sampling. Associations between guideline publication and biopsy practices were analyzed using logistic regression models. Results: A total of 3298 patients were included. Biopsies were obtained from one esophageal segment in 12.6% of patients, two segments in 63.6%, and three segments in 23.8%. Adherence to guideline‐recommended biopsy strategies improved over time, with reduced single‐segment sampling and increased use of ≥ 2 segments. Distal esophageal biopsies provided the highest diagnostic sensitivity, and sampling that included the distal segment achieved sensitivity above 97%, particularly when combined with middle esophageal biopsies. EREFS reporting increased from 88–90% to over 98% in recent years. DD decreased significantly over time (approximately 0.7 years per calendar year), accompanied by a shift from mixed/stricturing to inflammatory phenotypes. Conclusion: Increased alignment with international guidelines, reflected by standardized endoscopic reporting and multi‐segment biopsy protocols, was associated with improved diagnostic sensitivity, reduced DD, and fewer fibrostricturing presentations.

Background: Real-world data on dupilumab for eosinophilic esophagitis (EoE), particularly regarding flexible dosing and fibrostenotic phenotypes, are scarce. Objective: To evaluate the effectiveness and safety of dupilumab in clinical practice using the EoE CONNECT registry. Methods: This cross-sectional analysis included all patients prospectively recruited in the largest European multicenter EoE registry. Baseline characteristics, dosing regimens (300 mg weekly vs. semi-weekly), clinico-histological response (CHR), dose adjustments, and treatment tolerability were assessed. Results: We analyzed 161 patients (145 adults; 16 adolescents). At baseline, 69.1% of patients displayed endoscopic fibrotic features (rings/strictures). After a median of 6.5 months, peak eosinophil count decreased from 57±45 to 8±19 eos/hpf, EREFS score declined from 3.0±1.6 to 1.3±1.3, and DSS improved from 5.8±3.7 to 2.5±2.8 (all p<0.001). CHR was achieved by 86.0% of patients on 300 mg weekly and 81.2% on semi-weekly dosing (p=0.57). Multivariate analysis identified severe atopy as the reason for starting dupilumab as the strongest predictor for semi-weekly regimen choice (OR: 26.9; p<0.001), with conjunctivitis, asthma, and having two or more food allergies being significant. Both regimens were equally effective in reducing peak eos/hpf, symptomatology and EREFS. Dose tapering from weekly to semi-weekly/monthly was successful in all evaluable cases (8/8), while dose escalation from semi-weekly to weekly rescued 80% (4/5) of non-responders. Discontinuation occurred only in 8 patients (5%), primarily due to adverse events. Conclusion: Dupilumab is effective and safe in real-world EoE management, with no significant differences between weekly and semi-weekly induction. Efficacy was generally regained after escalation or maintained after dose tapering.

Background: Remimazolam (RM) is an ultrashort‐acting benzodiazepine with pharmacodynamic properties ideal for procedural sedation in emergency departments (EDs). This study evaluated the safety of RM when used for procedural sedation of American Society of Anesthesiologists (ASA) I–III patients in the ED. Aims: To compare the occurrence of no or mild/moderate respiratory complications during procedural sedation in patients with ASA scores I, II, and III. Secondarily, to compare clinical characteristics of RM sedations between the ASA groups. Methods: This qualitative improvement study was conducted in 2024 and 2025 at a Danish Level 1 trauma center. RM was administered to ASA I–III patients ≥ 12 years of age as procedural sedation by emergency medicine physicians or nurses educated in airway management, RM sedation, and adverse events. Safety was measured by the occurrence of respiratory problems graded as none, mild, moderate, or severe. Results: Of the 540 patients sedated with RM, 95%–100% in ASA I–III had no or mild/moderate respiratory complications, with ASA I and III being the safest groups ( p < 0.014). ASA III patients had the most potential airway risks, but still experienced fewer severe respiratory complications than ASA II patients (4.7% vs. 1.3%, p = 0.014). The RM dose was found to be age‐, gender‐ and ASA score‐dependent. Conclusions: RM showed great potential for procedural sedation and was safe for procedural sedation of ASA I–III patients in the ED, with few serious respiratory complications, even in high doses and with high‐risk profiles.

Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated oesophageal disease characterised by eosinophilic infiltration and symptoms of oesophageal dysfunction [1]. Effective therapies exits; ...

Background: The Acute Basic Palliation Concept (ABPC) — a structured end-of-life (EoL) care model — has shown increased quality of EoL care when used in hospital settings. Aim: To measure if the use of the ABPC could increase symptom relief and user satisfaction when applied in general practice. Design & setting: This cohort study was conducted across nine general practices in Northern Denmark with 29 GPs, as well as 10 representatives from the regional out-of-hours GP service. Method: GPs received training in an adapted ABPC and subsequently reported on patient cases managed both with and without the concept. Data on symptom control and satisfaction were collected via questionnaires from relatives, municipal caregivers, and GPs. Results: A total of 74 EoL care trajectories were included in the analysis, with 51% managed using the structured concept. The mean patient age was 84 ±8.9 years; 46% were female. The median duration from EoL care initiation to death was 3.0 (interquartile range 2.0–7.0) days. When using the concept, symptom control increased for pain (97% versus 83%), agitation (93% versus 56%), and discomfort (93% versus 81%; all P <0.05). Shortness of breath was less frequent, with a trend toward improved symptom relief using the concept (81% versus 54%). Most staff were willing to use the concept again (90% GPs and 100% municipal nurses). Conclusion: The structured ABPC model facilitated adequate symptom management and was widely accepted among GPs and municipal nurses, demonstrating promising potential for EoL care in a general practice setting.

Introduction: End-of-Life (EOL) care is essential for alleviating patients' suffering in their final days. An Acute Basic Palliation Concept (ABPC) includes a checklist for doctors and nurses, patient information materials, a medication box, and a decision-making tool for municipal nurses. The concept was developed to support patients, relatives, and healthcare professionals in relieving suffering in elderly, frail, and terminally ill patients, who prefer to die at home. The aim of this study was to investigate the amount of medication and utensils necessary for EOL care when using the ABPC on patients without specialized palliative needs and a life expectancy of days. Methods: This observational study was conducted in the North Denmark Region. Forty dying patients were discharged from the emergency departments using the ABPC, which included a pre-packed box of medicine and utensils for EOL care. When the patient had passed away, the boxes were collected, the remaining medication and utensils counted, and the used medicine calculated. Results: The remaining contents of 32 out of 40 boxes were counted after the completion of the patient-treatment process. The last eight boxes had been sent for destruction by the healthcare staff. Median time to death was 2.0 (1;3) days, mean age was 85 (standard deviation 9.4) years, and 69% were women. Availability of 20 vials of Morphine (10 mg/mL), 18 vials of Midazolam (5 mg/mL), four vials of Haloperidol (2.5 mg/mL), six vials of Glycopyrronium (0.1 mg/mL), and six suppositories of Bisacodyl (10 mg), was sufficient for covering the needs of 95% of the patients receiving EOL care. Conclusions: The number of medication vials needed for EOL care in 95% of patients without special needs was documented in this study of 32 patients.

Baggrund: I Danmark har der i de seneste år været en øget tilstrømning af patienter til akutmodtagelserne med et resulterende pres på arbejdsmiljøet. I Akutmodtagelsen på Aalborg Universitetshospital valgte man at undersøge, om en smartphone-applikation (app) til koordinering af patientflow kunne øge personalets oplevede psykiske arbejdsmiljø gennem blandt andet bedre kommunikation. Formål: At teste, om det oplevede psykiske arbejdsmiljø kunne forbedres for læger og sygeplejersker i afdelingen ved at implementere koordinationsappen. Metode: En QR-kode til et elektronisk spørgeskema blev hængt op i afdelingen. Alle medarbejdere i afdelingen blev opfordret til daglig besvarelse. Spørgeskemaet var tilgængeligt syv dage før og syv dage efter implementeringen af appen. QR-koden og spørgeskemaet blev også nævnt til hver morgenkonference. Spørgsmålene blev besvaret på en 0-100 visuel analog skala (VAS). Resultat: Spørgeskemaet blev besvaret af 61 ansatte (11 koordinatorer, som er læger og sygeplejersker, der koordinerer patientflow) før implementeringen og 51 ansatte (17 koordinatorer) efter implementeringen. Det oplevede ”arbejdsmiljø i travle perioder” blev generelt scoret lavt før implementeringen (koordinatorers median VAS-score 38 (interkvartilområde (IQR): 16;50) og ikke-koordinatorers median VAS-score 50 (IQR: 32;76), p-værdi = 0,06). Den subjektivt bedømte ”arbejdsmiljøscore” steg signifikant efter implementeringen af koordinationsappen for koordinatorerne (median VAS-score 70 (IQR: 51;82) versus 38 (IQR: 16;50), p-værdi = 0,005). Det samme skete for ”kommunikationsscoren” for koordinatorerne (median 58 (IQR: 35;71) før versus 79 (IQR: 70;79) efter implementering, p-værdi = 0,01). Permanent implementering af koordinationsappen ønskedes af 71 % af koordinatorerne. Konklusion: Arbejdsmiljøet var generelt lavt i en stor akutafdeling på Aalborg Universitetshospital i Danmark. Efter implementeringen af en koordinationsapp øgedes arbejdsmiljøscorerne for koordinatorer sammen med deres scorer for kommunikation. Den eksterne validitet til andre store danske akutafdelinger forventes at være høj.