No abstract

Artículo de publicación ISIThis article has an accompanying continuing medical education activity on page e17. Learning Objective: Upon completion of this test, successful learners will be able to: (1) learn first-line treatment for the induction of remission in microscopic colitis; (2) identify the expected clinical benefits and adverse effects of induction therapy for microscopic colitis; (3) understand the indications for and dosing of maintenance therapy for microscopic colitis; (4) consider medications that may precipitate microscopic colitis especially in those who are refractory to medical therapy; and (5) become familiar with treatment strategies for microscopic colitis refractory to first-line therapy

and T.C.M.F. performed all of the retrovirus transductions and confocal microscopy. J.U. developed the PEPCK tetramer and provided advice on its use. N.G. and W.R.H. produced the Plasmodium peptide-MHC I tetramer and helped design the PbT-I cell-killing assays.

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15 per high-power field over a short-term treatment period of 4e12 weeks, but very low certainty about the effects of using topical glucocorticosteroids as maintenance therapy. Multiple dietary strategies may be effective in reducing esophageal eosinophil counts to <15 per high-power field over a short-term treatment period, with moderate certainty for elemental diets, low certainty for empiric 2-, 4-, and 6-food elimination diets, and very low certainty that allergy-based testing dietary eliminations have a higher failure rate compared to empiric diet elimination. There is very low certainty for the effect of proton pump inhibitors in patients with esophageal eosinophilia. Although esophageal dilation appears to be relatively safe, there is no evidence that it reduces esophageal eosinophil counts. There is very low certainty in the effects of multiple other medical treatments for EoE: antieinterleukin-5 therapy, antieinterleukin-13 therapy, anti-IgE therapy, montelukast, cromolyn, and anti-TNF therapy.