SUMMARY: Esophageal food impaction (EFI) is the leading complication in patients with undiagnosed eosinophilic esophagitis (EoE). Limited data exists on pre-hospital care, in-hospital management, and post-hospital follow-up in suspected EoE-associated EFI. This study aims to assess deviations between real-life management and guideline-based recommendations in suspected EoE-associated EFI. This retrospective multicenter study analyzed data from four major Swiss gastroenterology units on patients with EoE-associated EFI. Patients with GERD-related strictures or esophageal cancer were excluded. Data on demographics, emergency department (ED), endoscopy management, and follow-up were obtained from electronic health records. Associations between clinical factors and odds of biopsy were analyzed using logistic regression. Between January 2015 and December 2020, 198 EFI cases (median age 51 years, 29.8% female, 28% with previous EFI) were recorded. Patient delay—the time between symptom onset and ED admission—was ~ 270 minutes. Nearly all patients (94%) required endoscopic bolus removal. The median time from ED presentation to endoscopy was ~150 minutes. Esophageal biopsies were taken in just over half of the individuals (n = 97, 52%), leading to a new EoE diagnosis in 71 (68.9% of those biopsied). Biopsy odds decreased significantly with older age (OR 0.96; 95% CI 0.94–0.98, P < 0.05) and known EoE (OR 0.26; 95% 0.09–0.69, P < 0.05). Although EoE is a leading cause of EFI, too few patients with a high baseline probability of EoE undergo biopsy in the emergency setting. Among those biopsied, the majority received a new EoE diagnosis, highlighting the importance of histological assessment.

Results on exposure-efficacy relationships for vedolizumab in patients with Crohn’s disease are contentious. Our study aimed at exploring the relationship between vedolizumab serum concentrations measured during induction and maintenance and treatment outcomes in Crohn’s disease patients in a real-world setting. Crohn’s disease patients treated with vedolizumab between January 2014 and July 2022 at our tertiary care centre were included. Serum vedolizumab concentrations were measured on at least one of the following time points: week 2, 6, 12, 26, and/or 52. Treatment efficacy was evaluated at weeks 12, 26 and 52 as clinical remission based on patients reported outcomes, faecal calprotectin and C-reactive protein remission. In total, 58 patients (55.2% females) were included. At baseline, active disease, defined either by increased faecal calprotectin, C-reactive protein or patients reported outcomes, was observed in 53 patients (91.4%). Week 12 vedolizumab serum levels were higher in clinical remitters versus non-remitters at weeks 12 and 52 (p <0.05). However, in adjusted multivariate analyses no association between vedolizumab levels and therapy outcomes was observed. In our retrospective study, vedolizumab serum concentrations measured during induction treatment were not associated with clinical and feacal calprotecin remission at weeks 12, 26 and 52.

Summary: Eosinophilic esophagitis is a chronic immune-mediated disease requiring a long-term maintenance treatment. The data on therapy patterns and treatment durability in the biologic era are scarce in a real-world setting. The aim of this project was to provide information on the treatment courses in a real-world setting over past 10 years. Data on demographics, concomitant atopic diseases and treatments were collected retrospectively at seven Austrian centres. The eligible subjects had to start their first therapy between January 2014 and February 2025. In total, 336 patients (30.1% female) were analyzed of whom 34.5% remained on the first line treatment. In a mean time of 7.6 months, a second line treatment was started. The most common first line treatment was swallowed topical corticosteroids (STCs) (54.2%), followed by proton pump inhibitors (22.3%) and food elimination diet (6.0%). In contrast to only a minority who continued on PPI therapy after starting it (21.3%), the majority of patients had ongoing STC treatment (51%). Forty-one (12.2%) patients received a treatment with dupilumab of whom only one as first line treatment (because of multiple type 2 inflammatory diseases) and the majority as second line treatment (57.5%). The reasons for dupilumab were non-response to STC (59%), followed by side effects (24%). 97.6% (40/41) of them remained on dupilumab until the last follow-up. Although most patients receive STC at the beginning, the majority need multiple treatment lines. Dupilumab is used in a tenth of patients due to refractoriness, side-effects or treatment of other type 2 inflammatory diseases.

We present here a case of a 39-year-old patient who presented with celiac-disease-like symptoms and MARSH 3a histology in duodenal biopsies under normal diet. Interestingly, HLA genotyping and celiac-specific serology were negative, primarily leading to exclusion of celiac disease. However, biopsies from a second endoscopy a couple of months later (still under normal diet) showed histologic progression of the disease to MARSH 3b and led to the re-evaluation of the out-of-hospital-obtained histological samples by a pathologist experienced in celiac disease. The second biopsy described previously as MARSH 3b turned out to be non-specific and was therefore re-classified as MARSH 0. After all known causes of duodenal villous atrophy were excluded by a thorough evaluation, a correlation between the first biopsy (MARSH 3a) and Truvada intake could be established. After Truvada discontinuation and under normal diet, normalisation of duodenal mucosa was observed, leading to the assumption that Truvada could lead to celiac-like enteropathy.