Eosinophilic esophagitis in adults is a recently described entity occurring in young males with dysphagia, in whom esophageal biopsies show eosinophilic infiltration. This study defines the clinical and histological features of patients with eosinophilic esophagitis, distinguishing it from gastroesophageal reflux disease. Esophageal biopsies from patients with dysphagia or esophagitis were reviewed blindly, and assessed for: epithelial eosinophil counts, presence of eosinophilic microabscesses, edema, basal zone hyperplasia, lamina propria papillae elongation, eosinophils and fibrosis. Clinical and endoscopic findings were obtained. Eosinophilic esophagitis was diagnosed with epithelial eosinophils Z15 in Z2 high-power fields (hpfs) or Z25 in any hpf. Analysis was performed with Mann-Whitney, v 2 and ANOVA tests. Of 157 cases, 41 had eosinophilic esophagitis. Male gender (81%) and age r45 (54%) were commoner in patients with eosinophilic esophagitis (P ¼ 0.001, 0.010, respectively). Dysphagia was more common in eosinophilic esophagitis patients (63%, Po0.001); heartburn was more common in noneosinophilic esophagitis patients (53%, Po0.001). Endoscopic rings were more common in eosinophilic esophagitis patients (27%, P ¼ 0.023); hiatus hernia was more common in noneosinophilic esophagitis patients (11%, P ¼ 0.022). Eosinophils were more numerous in eosinophilic esophagitis biopsies (mean 39/hpf, Pr0.001). Only eosinophilic esophagitis biopsies had eosinophilic microabscesses (42%, Pr0.001). Edema, basal zone hyperplasia, lamina propria papillae elongation and lamina propria eosinophils were commoner in eosinophilic esophagitis (P ¼ o0.001-0.002), while lamina propria fibrosis was specific for eosinophilic esophagitis (39%, Po0.001). Eosinophilic esophagitis is a disease with a predilection for young males with dysphagia and rings on endoscopy. Biopsies in eosinophilic esophagitis have high epithelial eosinophil counts, averaging nearly 40/hpf. Increased awareness of eosinophilic esophagitis is necessary, since treatment with allergen elimination or antiinflammatory therapy may be more effective than acid suppression.

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: We evaluated the use of utility measurements to assess the quality of life of patients with Crohn's disease. Utility scores were obtained using the Time Trade-Off (TTO), Standard Gamble, and Visual Analog Scale (VAS) methods in 180 consecutive patients with Crohn's disease. The mean utility scores of patients with a spectrum of disease severity were compared with other measures of disease activity to assess the operating properties of these instruments. All methods of utility estimation yielded lower mean scores in patients with more severe disease. (Remission versus chronically active, therapy resistant disease: TTO 0.96 versus 0.88; Standard Gamble 0.88 versus 0.74; VAS 0.84 versus 0.61). TTO scores were consistently higher than those derived by the other methods (p = 0.001). The utility scores were reliable in patients who were stable (intraclass correlation coefficient 0.55-0.84), but were less responsive than the Crohn's Disease Activity Index (responsiveness ratio 0.97-1.3 versus 2.10) to changes in disease severity. Patients with active Crohn's disease have decreased quality of life as measured by utility scores. Although utilities are valid and reliable quality of life assessments, they are less responsive than other measures of outcome used for clinical trials.