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Eosinophilic esophagitis is a chronic allergen driven immune mediated disease that is increasingly recognized as a leading cause of dysphagia and foregut symptoms in children and adults. Much knowledge has been gained in recent years on the genetic and environmental risk factors for this disease, the associated inflammatory milieu, and the long term complications from esophageal remodeling. In this review we will highlight recent progress made in research into this disease, focusing on adults. We will discuss ongoing efforts to develop a minimally invasive technique that may obviate the need for repeated endoscopic assessment of disease activity. Moreover, we will review studies using novel tools such as mucosal impedance and functional lumen imaging as potential surrogate markers for mucosal integrity and esophageal remodeling. With regard to the treatment of eosinophilic inflammation, we will discuss the controversies surrounding responsiveness to proton pump inhibitors in some patients. Therapeutic trials continue to support the use of topical glucocorticoids and empiric food elimination diets as first line treatments. We will discuss ongoing efforts to optimize the elimination diet protocol to decrease the level and duration of food restrictions. Looking ahead, our growing knowledge on the pathogenesis of eosinophilic esophagitis has enabled further advancement of promising targeted biologic therapies.

Davie’s suggestion of a therapeutic trial may be useful and has been used formerly as part of a diagnostic strategy.1 2 3 But we would caution against relying on the response to furosemide because this drug reduces oedema from any cause, whereas non-cardiac oedema will not respond to angiotensin converting enzyme inhibitors. However, the use of B-type natriuretic peptide and echocardiography provides—in addition to diagnosis—prognostic, aetiological, and therapeutic information. There are several possible investigations for coronary disease and an individualised approach is recommended. …

Imagine an intervention whose effects vary within and between individuals and depend on subtle interactions between deliverers and recipients, and in which exposure is uncertain. Given this complexity, who would contemplate conducting a randomised controlled trial? In fact, all these issues must be dealt with in drug or therapeutic trials, as well as in …

Twenty years after editorial behaviour that has been described by one observer as “absolutely outrageous,” the journal at the heart of the affair has apologised to the doctors concerned. In 1983 Dr Jon Tyson and colleagues, from the department of paediatrics at the University of Texas, published an analysis of the quality of therapeutic trials in perinatal medicine in the Journal of Pediatrics. The authors concluded that the papers they looked at were …

The bone mineral mass was estimated by photon absorptiometry in 23 epileptic patients on long-term treatment with phenytoin and in 20 normal subjects before and during treatment with vitamin D or placebo. Initially, subnormal values of bone mineral mass were found in the epileptic patients. The group of epileptic patients treated with vitamin D showed a significant increase in bone mineral mass. The group of epileptic patients treated with placebo and the normal subjects treated with vitamin D or placebo showed no change in bone mineral mass.