Jennifer L. Horsley-Silva

Introducción y objetivos. La esofagitis eosinofílica es una enfermedad inflamatoria crónica del esófago mediada por una respuesta inmune tipo 2 y desencadenada principalmente por alérgenos alimentarios. Su incidencia y prevalencia han aumentado de manera significativa en las últimas décadas, convirtiéndose en una causa frecuente de disfagia y obstrucción esofágica. El objetivo de esta revisión narrativa es sintetizar la evidencia actual sobre el diagnóstico y tratamiento de la EEo, con énfasis en aspectos aplicables a la práctica clínica en Latinoamérica. Material y métodos. Se realizó una revisión narrativa de la literatura publicada en PubMed y bases complementarias hasta mayo de 2025. Se incluyeron estudios originales, revisiones sistemáticas, guías de práctica clínica y consensos internacionales relevantes para el diagnóstico y manejo terapéutico de la EEo. Resultados. El diagnóstico requiere la integración de la clínica con hallazgos endoscópicos e histológicos, utilizando sistemas estandarizados como los puntajes EREFS y EoEHSS. En cuanto al tratamiento, los inhibidores de la bomba de protones, los esteroides tópicos deglutidos y las dietas de eliminación constituyen las terapias de primera línea. La introducción de agentes biológicos, en particular dupilumab, ha ampliado el espectro terapéutico para pacientes con enfermedad refractaria. La dilatación endoscópica se considera segura y eficaz en casos fibroestenosantes. La vigilancia a largo plazo debe incluir evaluación clínica, endoscópica e histológica, dado que los síntomas no siempre reflejan la actividad inflamatoria. Conclusión. La EEo es una enfermedad crónica que requiere diagnóstico temprano y manejo integral. A pesar de los avances terapéuticos, persisten desafíos relacionados con la disponibilidad de fármacos específicos, biomarcadores no invasivos y estrategias de seguimiento costo-efectivas, los cuales representan áreas prioritarias de investigación futura.

Capillary malformation-arteriovenous type 2 syndrome (CM-AVM2) is a rare, genetic vascular disorder associated with abnormal capillary malformations and arteriovenous malformations. We present a case of CM-AVM2 with refractory diarrhea and failure to thrive due to aberrant, telangiectatic capillaries, and subepithelial collagen deposition found throughout the GI tract on bidirectional endoscopy. The patient was recalcitrant to standard therapies, so bevacizumab was trialed, but the patient expired. This is the first case of CM-AVM2 with diffuse GI mucosal involvement resulting in malabsorption. There is no treatment for this pathology, but treatment with bevacizumab or a mammalian target of rapamycin inhibitor may be efficacious.

INTRODUCTION: We aimed to assess the diagnostic utility of eosinophil peroxidase (EPX) staining on Cytosponge (CS) samples in eosinophilic esophagitis (EoE). METHODS: Esophageal biopsy (BX) samples from adult subjects with EoE were assessed using peak eosinophils per high-power field (eos/hpf), EPX, and the EoE histologic scoring system. EPX staining and eos/hpf were compared (BX vs CS). RESULTS: CS EPX positivity correlated with eos/hpf (CS [r = 0.82, P < 0.0001]; BX [r = 0.65, P < 0.0001]) and EoE histologic scoring system (grade [r = 0.62, P < 0.00001]; stage [r = 0.61, P < 0.0001]). CS EPX identified subjects with active EoE (area under the curve = 0.86, P < 0.0001). DISCUSSION: The correlation of CS EPX with eosinophilic inflammation and histologic disease severity supports its diagnostic utility in EoE.

Background: Inpatient status has been shown to be a predictor of poor bowel preparation for colonoscopy; however, the optimal bowel preparation regimen for hospitalized patients is unknown. Our aim was to compare the efficacy of bowel preparation volume size in hospitalized patients undergoing inpatient colonoscopy. Methods: This prospective, single blinded (endoscopist), randomized controlled trial was conducted as a pilot study at a tertiary referral medical center. Hospitalized patients undergoing inpatient colonoscopy were assigned randomly to receive a high, medium, or low-volume preparation. Data collection included colon preparation quality, based on the Boston Bowel Preparation Scale, and a questionnaire given to all subjects evaluating the ability to completely finish bowel preparation and adverse effects (unpleasant taste, nausea, and vomiting). Results: Twenty-five colonoscopies were performed in 25 subjects. Patients who received low-volume preparation averaged a higher mean total BBPS (7.4, SD 1.62), in comparison to patients who received high-volume (7.0, SD 1.41) and medium-volume prep (6.9, SD 1.55), P = 0.77. When evaluating taste a higher score meant worse taste. The low-volume group scored unpleasant taste as 0.6 (0.74), while the high-volume group gave unpleasant taste a score of 2.2 (0.97) and the medium-volume group gave a score of 2.1 (1.36), P < 0.01. Conclusion: In this pilot study we found that low-volume colon preparation may be preferred in the inpatient setting due its better rate of tolerability and comparable bowel cleanliness when compared to larger volume preparation, although we cannot overreach any definitive conclusion. Further more robust studies are required to confirm these findings. Trial registration: The Affect of Low-Volume Bowel Preparation for Hospitalized Patients Colonoscopies. Trial registration: NCT01978509 (terminated). Retrospectively registered on November 07, 2013.