Helicobacter pylori infection is associated with decreased odds for eosinophilic esophagitis in Mexican patients

BACKGROUND

The incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients.

PATIENTS AND METHODS

We evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case.

RESULTS

We included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08-0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06-0.69, p < 0.001), particularly allergic rhinitis and food allergy.

CONCLUSIONS

We observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship.

Allergic sensitization in low-income urban children: relationship with current symptoms of asthma and rhinitis

BACKGROUND

Recent information on the prevalence of allergic sensitization (AS) in children from low-income urban areas is limited.

METHODS

We conducted a cross-sectional, randomized, population-based study to determine the prevalence of AS, and its relationship with asthma and rhinitis in low-income schoolchildren in Santiago, Chile. The parents answered a standardized questionnaire on respiratory symptoms, and a skin prick test (SPT) for common aeroallergens was performed on all children.

RESULTS

In the 545 schoolchildren studied (mean age 8.3 ± 0.9 years), the prevalence of positive SPT was 25.5%. The current prevalence of asthma, rhinitis, and rhinoconjunctivitis was 20%, 43.4%, and 27.8%, respectively. SPT was positive in 30.6%, 32.8%, and 38.0% of children with current asthma, rhinitis, and rhinoconjunctivitis, respectively. Positive SPT was significantly associated with rhinitis and rhinoconjunctivitis (p < 0.001) but not with asthma. Breastfeeding for at least 4 months was significantly protective against AS (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.26-0.78; p = 0.008); no other factor studied was associated with AS.

CONCLUSIONS

The prevalence of AS was low; less than 40% of children with current asthma, rhinitis, or rhinoconjunctivitis symptoms evidenced AS. The prevalence of non-atopic asthma and rhinitis is consistent with previous findings in children from low-income urban areas. Other environmental factors, such as the high burden of respiratory infections and environmental pollution, might be more critical than atopy for developing asthma and rhinitis in schoolchildren from deprived urban areas.

Geographic Tongue: What a Dermatologist Should Know

Geographic tongue, also known as benign migratory glossitis, is a benign chronic inflammatory condition of the tongue. It is characterized by erythematous lesions with filiform papillae atrophy, surrounded by white limited areas in the dorsal and lateral aspects of the tongue, producing a map-like aspect. This lesions change in size and shape with time, and are characterized by periods of exacerbation and remission without scaring. The cause is unknown, but multiple associations have been described, which will be discussed below.

In-hospital acute myocardial infarction: A case of type II Kounis syndrome

Kounis syndrome (KS) is the coincidental occurrence of acute coronary syndrome (ACS) and anaphylactic or allergic insult. It results from mast cell degranulation with subsequent release of numerous inflammatory mediators, leading to coronary vasospasm or atheromatous plaque rupture. Diagnosis is clinical and based on the temporal relationship between the two events. Despite the growing number of reported cases, especially in southern Europe, the lack of awareness of this association may lead to under-reporting in Portugal. Recognition of KS, even if retrospective, has clinical implications since individual atopy must be investigated and desensitization measures should be employed, if possible, to prevent future events. We report the case of a 70-year-old man who was admitted to hospital because of generalized exanthema and itching and onset of chest pain while under observation. Coronary angiography confirmed coronary artery disease and ACS and he was diagnosed as having type II KS.

Ocular Surface Squamous Neoplasia Associated with Atopic Keratoconjunctivitis

PURPOSE

To describe 2 cases of invasive squamous cell carcinoma that originated in the setting of severe atopic keratoconjunctivitis (AKC).

METHODS

Case one involved a 73-year-old male with atopic eczema and severe AKC who developed a limbal lesion suspicious for ocular surface squamous neoplasia (OSSN). Slit-lamp examination was significant for a new sessile lesion in the temporal limbal region of the left eye. The lesion was treated with excisional biopsy and cryotherapy. Topical therapy with mitomycin C, topical interferon alpha 2b, and topical 5-fluorouracil provided only partial control. Exenteration was eventually needed. Case two involved a 53-year-old male with history of severe AKC and eczema. Computed tomography imaging showed an infiltrative mass of the right orbit. Incisional biopsies confirmed conjunctival squamous cell carcinoma of both sides (invasive in the right eye, in situ in the left eye). Exenteration was needed for control of invasive carcinoma in the right eye.

RESULTS

Squamous cell carcinoma was treated without success in spite of surgical excision and aggressive treatment with multiple topical agents and multiple applications of cryotherapy. Orbital exenteration was needed in both cases.

CONCLUSION

Chronic inflammation associated with AKC may be a risk factor for the development of bilateral, diffuse, invasive, and recurrent OSSN that may require exenteration.