Background Despite being found with increasing frequency on esophageal biopsies, the clinical significance of lymphocytic esophagitis (LE) remains poorly understood. Goals The primary aim of our study was to characterize the clinical presentation and natural history of LE among adult patients. Study We retrospectively reviewed records for all 81 adult patients at the University of Michigan Medical Center who had a histopathological diagnosis of LE between January 1998 and November 2009. Patient demographics, clinical history, laboratory data, and imaging results from the time of diagnosis were obtained through review of computerized medical records. A telephone survey was conducted to collect natural history data. Results The number of LE diagnoses increased over time, with 81.5% (n=66) of patients being diagnosed in the last three years. The most frequent symptoms at the time of presentation were dysphagia (n=54), chest/abdominal pain (n=36), and heartburn (n=38). The majority (58.6%) of patients reported improvement in their initial gastrointestinal symptoms – most commonly associated with initiation of a proton pump inhibitor. Upon follow-up, most patients reported a good quality of life and satisfaction with their current health status. Conclusions Lymphocytic esophagitis is a new clinical entity with an increasing incidence. LE appears to have a benign natural history, with most patients reporting an improvement in symptoms and satisfaction with their health-related quality of life. Prospective studies are needed to better characterize the natural history and potential treatments for this clinical entity.

The treatment armamentarium in pediatric Crohn disease (CD) is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet]), which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn’s and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario), inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies). Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.

Children's behavior toward adults who differed from them along two dimensions was examined from a developmental perspective. White boys and girls from kindergarten and fourth grade were tested individually by either a black or a white female adult who either was or was not seated in a wheelchair. Three kinds of behavior toward the adult were measured: physical distancing, imitation, and helping. On the basis of previous findings, we predicted that children at both age levels would show more physical avoidance, less imitation, and less helping in the presence of other-race and handicap cues, as compared with own-race and nonhandicap cues. On all three types of behavior, the white experimenter was favored over the black experimenter in both the wheelchair and nonwheelchair conditions. In addition, there were interaction effects involving race, handicap, age, and sex that suggest the operation of complex developmental processes in the formation of attitudes toward different types of stigmatized individuals.Previous research suggests that white children of elementary school age tend to react negatively to the physically handicapped (e.g.,

Abery, B. (1992). Abstract of OSERS Project H023J2001. Abery, B. (1994). A conceptual framework for enhancing self-determination. In M. Hayden & B. Abery (Eds.), Challenges for a service system in transition: Ensuring quality community experiences for persons with developmental disabilities (pp. 345-380).