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Eosinophilic esophagitis (EoE) is the most common cause of esophageal food impaction (EFI). Approaches to management of EFI due to EoE have not been well characterized. We conducted a web-based survey to understand approaches to management of EFI due to EoE among endoscopists. Questions focused on management of patients from presentation to post-endoscopy follow-up. The survey was administered to a list of eligible candidates provided by societies of gastroenterology. A total of 308 endoscopists completed the questionnaire. The majority (83%) practiced in Europe and treated adults (78%). Most agreed patients should be advised to seek emergency care (66%) within 1 to 2 hours (41% agreement). There was agreement that medications to induce vomiting should be avoided (84%) and that blood tests or imaging studies were usually not required before endoscopy. By contrast, there was more variability in the type of sedation recommended and the need for endotracheal intubation, especially when comparing more experienced with less experienced EoE-endoscopists. Overall, fewer than half (43%) respondents recommended obtaining esophageal biopsies during the initial endoscopy. However, there were significant differences in the proportion who recommended biopsies based on level of EoE-experience (25, 52, 77%, P  < 0.001; less vs. moderate vs. very experienced) and comparing pediatric and adult endoscopists (32, vs. 79%, P  < 0.001; adult vs. pediatric). There exists heterogeneity among endoscopists in recommendations to manage EFI in patients with EoE. These findings support development of clinical guidelines and new studies to clarify the rationale for best practices. Key summary: Established knowledge —The optimal management of patients with esophageal food impaction due to eosinophilic esophagitis from presentation at the emergency department to postendoscopy care is unclear. New findings —Considerable recommendation variation exists in the management of EFI in patients with EoE. Our findings provide a rationale for the creation of consensus practice guidelines and further study into best practices. [ABSTRACT FROM AUTHOR]

For decades, historians have debated why Germany's Chancellor Heinrich Brüning resorted to policies worsening the economic crisis in the early 1930s. Some scholars, first and foremost Knut Borchardt, have argued that for various reasons the Chancellor had no choice but to depress the economy. In particular, Borchardt has pointed out that Brüning was reluctant to devalue the currency because he feared a return of hyperinflation. Borchardt's critics, by contrast, have rejected this argument on the grounds that Brüning's fear of devaluation was not shared by all German policy-makers and the public in general. This article tries to make a contribution to this debate by assessing Brüning's fear of devaluation from a comparative perspective. Narrative evidence from Britain, the Netherlands, the Scandinavian countries and Switzerland strongly suggests that Borchardt's argument is well grounded. Across Europe, politicians and central bankers, as well as business and union leaders, were convinced that devaluation would lead to inflation and do more harm than good. The evidence also shows that, because of this widespread fear of inflation, not a single European country deliberately devalued its currency in the 1930s. [ABSTRACT FROM AUTHOR]

Introduction: For 1.3-1.9 million patients suffering from drug-resistant focal epilepsy in Europe alone, neurosurgery is often the only path to seizure freedom. The delineation between healthy and epileptogenic tissue relies on MRI and other diagnostics and can be further refined through intraoperative electrocorticography (ioECoG). Complete removal of tissue generating interictal electric discharges (IEDs, <80Hz) and high frequency oscillations (HFOs, 80-500Hz) in ioECoG correlates with a good surgical outcome. The precise link between IEDs/HFOs and MRI lesions, however, is unknown. We aim to identify this link and improve our understanding of how ioECoG and MRI findings should be weighed against each other to accurately delineate epileptogentic tissue. Methods: We retrospectively included patients from the HFO Trial (Van 't Klooster, 2015) who underwent ioECoG-tailored surgery for a single lesion and achieved seizure freedom (Engel 1a). All lesions and resection cavities were segmented based on pre- and postoperative MRI scans. We automatically detected and visually verified IEDs and HFOs in 1-minute ioECoG epochs. Using intraoperative photographs, the MRI-coordinates of all ioECoG electrodes were determined on a rendering of the cortical surface. Results: 33 patients met our inclusion criteria. We will compare the number and rate of IEDs and HFOs per electrode with the volume of, and distance from the MRI lesion and subsequent resection cavity. We aim to find underlying functional relationships between those variables through regression analyses to better integrate MRI and ioECoG in our current model for tissue delineation. Conclusions: This study is ongoing, results are expected by mid-year 2021. [ABSTRACT FROM AUTHOR]

Background & Aims: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder. Swallowed topical-acting corticosteroids are effective in bringing active EoE into remission. However, it is not clear whether these drugs are effective for long-term maintenance of remission., Methods: We performed a double-blind trial to compare the efficacy and safety of 2 dosages of a budesonide orodispersible tablet (BOT) vs placebo in maintaining remission of EoE. Maintenance of remission was defined as absence of clinical and histologic relapse and no premature withdrawal for any reason. Two hundred and four adults with EoE in clinical and histologic remission, from 29 European study sites, were randomly assigned to groups given BOT 0.5 mg twice daily (n = 68), BOT 1.0 mg twice daily (n = 68), or placebo twice daily (n = 68) for up to 48 weeks., Results: At end of treatment, 73.5% of patients receiving BOT 0.5 mg twice daily and 75% receiving BOT 1.0 mg twice daily were in persistent remission compared with 4.4% of patients in the placebo group (P < .001 for both comparisons of BOT with placebo). Median time to relapse in the placebo group was 87 days. The frequency of adverse events was similar in the BOT and placebo groups. Morning serum levels of cortisol were in the normal range at baseline and did not significantly change during treatment. Four patients receiving BOT developed asymptomatic, low serum levels of cortisol. Clinically manifested candidiasis was suspected in 16.2% of patients in the BOT 0.5 mg group and in 11.8% of patients in the BOT 1.0 mg group; all infections resolved with treatment., Conclusions: In a phase 3 trial, up to 48 weeks of treatment with BOT (0.5 mg or 1.0 mg twice daily) was superior to placebo in maintaining remission of EoE. Both dosages were equally effective and well tolerated. EudraCT number; 2014-001485-99; ClinicalTrials.gov number, NCT02434029., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)