Histopathologic correlates of noncalcific chronic pancreatitis by EUS: a prospective tissue characterization study

BACKGROUND: Studies that correlated EUS features of chronic pancreatitis (CP) with histopathology are retrospective and only include patients with severe disease or calcific pancreatitis. Controversies regarding the significance of EUS features of noncalcific CP (NCCP) remain unresolved. OBJECTIVE: To correlate EUS criteria for NCCP with histology from surgical specimens. DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: All patients who underwent EUS for pancreaticobiliary indications and subsequent pancreatic surgery. Patients with calcific pancreatitis were excluded. METHODS: Individual CP features on EUS were carefully documented with relation to different parts of the pancreas. Standard EUS criteria for CP were adopted. All patients underwent surgery within 2 months of EUS. A single pathologist blinded to EUS findings reviewed the specimens and graded fibrosis (total score, 12; >or=6=unequivocal CP). A quantitative receiver operating characteristic (ROC) curve analysis was performed, and Spearman rank correlation coefficients were calculated. MAIN OUTCOME MEASUREMENTS: Correlate EUS criteria for NCCP, with histology from surgical specimens. RESULTS: Of the 42 patients evaluated, NCCP was diagnosed histologically in 21 patients (50%). None of the patients had CP diagnosis by CT. ROC curve analysis revealed that 4 or more EUS criteria provided the best sensitivity (90.5%), specificity (85.7%), and accuracy (88.1%) for diagnosing NCCP. Parenchymal EUS features that were significantly associated with histopathologic NCCP were foci (P<.0001), stranding (P<.001), and lobulations (P=.04); ductal features that were significantly associated with histopathologic NCCP were dilated (P<.0001) or irregular main pancreatic duct (P<.0001), side branches (P<.001), and hyperechoic duct margins (P=.03). There was a significant correlation between the number of EUS criteria and severity of NCCP on histology (r=0.85; P<.0001). LIMITATIONS: Small number of patients. CONCLUSIONS: An excellent correlation exists between EUS and histologic findings of NCCP.     

Quantitative diagnosis of chronic pancreatitis using EUS elastography

Journal of Gastroenterology - It is difficult to diagnose chronic pancreatitis (CP) objectively because of a lack of standard diagnostic criteria. Endoscopic ultrasonography (EUS) has been used to...     

Impact of etiology on the painful early stage of chronic pancreatitis: a long-term prospective study

BACKGROUND AND AIM: This prospective study aimed to investigate the impact of etiology on the pain profile in relation to alterations of function and morphology from early to advanced chronic pancreatitis (CP). METHODS: Our mixed medico-surgical cohort comprised 265 patients with alcoholic (ACP), 21 with idiopathic "juvenile" (IJCP), 46 with idiopathic "senile" (ISCP) and 11 with hereditary CP (HPCP). The patients were followed regularly from onset of disease according to the protocol published previously. RESULTS: Males predominated in ACP, IJCP, ISCP (> 71%) but not in HP (46%). Age at onset (median) was 10, 23, 36 and 62 years in HP, IJCP, ACP and ISCP, respectively. Follow-up from disease onset ranged from 14 to 36 years. The progression to late-stage CP, documented by exocrine insufficiency (86-100%) and calcification (80-91%) lasted 2 to 5-fold longer in HP/IJCP compared to ACP. Early stage CP, characterized by recurrent pancreatitis prevailed in > or = 90% of patients, except for those with ISCP (48%), and lasted up to 5-fold longer in HP/IJCP compared to ACP. Surgery for severe pain was required for ACP/IJCP in 57% of the patients compared to < 27% in HP/ISCP. Permanent pain relief regularly occurred in late-stage CP irrespective of etiology and surgery. CONCLUSION: The clinical profile of the 4 "etiological" subgroups is predictably different in the painful early (precalcific) CP stage.     

Confidence in the diagnosis of early spondylarthropathy: a prospective follow-up of 270 early arthritis patients

OBJECTIVE: To study the confidence of office-based rheumatologists (OBR) and a college of 5 experts in their diagnosis of spondylarthropathy (SpA) for early arthritis after more than 2 years of follow-up; to determine whether at that time the degree of confidence was improved by the fulfilment of the ESSG criteria. METHODS: 270 patients with early-onset (< 1 year) arthritis were prospectively followed-up for 29+/-11 months. At the final examination, OBR and the college of 5 experts rated their confidence in the diagnosis of SpA on a 0-10 analogue scale and on a 1-4 Likert scale, respectively. RESULTS: After 29+/-11 months OBR had classified 56 patients (21%) as SpA, while a collegial diagnosis of probable (N = 32) or certain SpA (N = 14) was made for 46 patients (17%). At the final examination OBR confidence in their diagnosis (gold standard) was only 6.7+/-2.4 for all 56 cases of SpA. The cumulative fulfilment of ESSG criteria for SpA after 29+/-11 months correlated with the confidence of OBR and the experts in SpA, but improved only slightly the final confidence of OBR (7.1+/-2.3 versus 6.7+/-2.4 for all 56 SpA). Similarly, OBR confidence for the 18/56 SpA patients positive for HLA-B27 was only 7.1+/-2.0. Only 21 of these 56 patients were considered as SpA at baseline, although 37/56 (66%) had fulfilled ESSG criteria since thefirst examination. CONCLUSION: This study indicates a probable lack of consensus on the nosology of early SpA and the limited help provided by the ESSG criteria to differentiate early SpA from otherforms of arthritis at baseline.     

Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study

OBJECTIVES: The aims of this study were to investigate the value of interventional endoscopy in patients with strictures of the common bile duct (CBD) caused by chronic pancreatitis (CP), and to define the subset of patients who may be at risk for failure of endoscopic intervention, in a prospective follow-up study. METHODS: A total of 61 patients with symptomatic CBD strictures caused by alcoholic CP were treated by endoscopic stent insertion for 1 yr with scheduled stent changes every 3 months. After the treatment period, all patients entered a follow-up program. RESULTS: Initial endoscopic drainage was successful in all cases, with complete resolution of obstructive jaundice. After 1 yr from the initial stent insertion, in 19 patients (31.1%) the obstruction was resolved, and stents were removed without any need of additional procedures. During a median follow-up of 40 months (range 18-66 months), 16 patients had no recurrence of symptomatic CBD stricture (long term success rate 26.2%). Of 45 patients who needed definitive therapy, 12 patients (19.7%) were treated with repeated plastic stent insertion and three (4.9%) with insertion of a metal stent, and 30 patients (49.2%) underwent surgery. Among the variables tested, calcification of the pancreatic head was the only factor that was found to be of prognostic value. Of 39 patients with calcification of the pancreatic head, only three (7.7%) were successfully treated by a 1-yr period of plastic stent therapy, whereas in 13 of 22 patients (59.1%) without calcification, this treatment was successful (p<0.001). CONCLUSIONS: Endoscopic drainage of biliary obstruction provides excellent short term but only moderate long term results. Patients without calcifications of the pancreatic head benefit from biliary stenting. Patients with calcifications were identified to have a 17-fold (95% CI=4-74) increased risk of failure of a 12 month course of endoscopic stenting.     

Sonographic diagnosis and follow-up of pneumonia: a prospective study

BACKGROUND: Although transthoracic ultrasound offers several important advantages as diagnostic imaging technique in pleural and pulmonary conditions, its significance for the diagnosis and monitoring of pneumonia has yet to be established. OBJECTIVES: To identify sonographic features associated with pneumonia at admission and during the course of the disease under treatment. METHODS: Thirty patients (12 females, 18 males; median age 65.5 years) with X-ray-proven pneumonia underwent transthoracic sonography (TS) on day 0, between days 1 and 3, 4 and 7, 8 and 14, 15 and 21, and after day 21. TS was assessed according to: number, location, shape, echogenicity, echotexture, echostructure, breath-depending movement, size of pneumonic lesions, bronchoaerogram, fluid bronchogram, superficial fluid alveologram, necrotic areas, vascularity and incidence of local and/or basal pleural effusion. RESULTS:Thirty-three pneumonic infiltrates were eligible for analysis in 30 patients. In 57% (17/30), the likely pathogenic microorganism was identified. Pneumonia was recognized as a hypoechoic area of varying size (mean size between 33.7 x 9.38 and 91.2 x 45.3 mm) and shape, with irregular and blurred margins along with a nonhomogeneous echotexture. The most characteristic feature was a positive bronchoaerogram (32/33). Sixty-one percent (20/33) revealed basal and 9% (3/33) local effusion. During follow-up, lesions decreased in size or disappeared (30/33) or decreased in number (4/9). The bronchoaerogram became less pronounced (13/32), basal pleural effusion either diminished (7/20) or dissipated (7/20), as did localized effusion (3/3). In 30 cases, the course of pneumonia was comparable using X-ray and TS. CONCLUSIONS: TS is a noninvasive technique for the diagnosis and follow-up of patients with pneumonia.     

The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers

BACKGROUND: Endoscopic ultrasound (EUS) is a minimally invasive, low risk method of diagnosis for chronic pancreatitis (CP). The degree to which endosonographers agree on the features and diagnosis of CP is unknown. For EUS to be considered an accurate test for CP, there must be good interobserver agreement. METHODS: Forty-five pancreatic EUS examinations were videotaped by 3 experienced endosonographers. Examinations from 33 patients with suspected CP based on typical symptoms, as well as 12 control patients without suspected CP, were included. Eleven experienced endosonographers ("experts") who were blinded to clinical information independently evaluated all videotaped examinations for the presence of CP and the following 9 validated features of CP: echogenic foci, strands, lobularity, cysts, stones, duct dilatation, duct irregularity, hyperechoic duct margins, and visible side branches. The experts also ranked (most to least) which features they believed to be the most indicative of CP. Interobserver agreement was expressed as the kappa (kappa) statistic. RESULTS: There was moderately good overall agreement for the final diagnosis of CP (kappa = 0.45). Agreement was good for individual features of duct dilatation (kappa = 0.6) and lobularity (kappa = 0.51) but poor for the other 7 features (kappa < 0.4). The expert panel had consensus or near consensus agreement (greater than 90%) on 206 of 450 (46%) individual EUS features including 22 of 45 diagnoses of CP. Agreement on the final diagnosis of CP was moderately good for those trained in third tier fellowships (kappa = 0.42 +/- 0.03) and those with more than 1100 lifetime pancreatic EUS examinations (kappa = 0.46 +/- 0.05). The presence of stones was regarded as the most predictive feature of CP by all endosonographers, followed by visible side branches, cysts, lobularity, irregular main pancreatic duct, hyperechoic foci, hyperechoic strands, main pancreatic duct dilatation, and main duct hyperechoic margins. The most common diagnostic criterion for the diagnosis of CP was the total number of features (median 4 or greater, range 3 or greater to 5 or greater). CONCLUSIONS: EUS is a reliable method for the diagnosis of chronic pancreatitis with good interobserver agreement among experienced endosonographers. Agreement on the EUS diagnosis of chronic pancreatitis is comparable to other commonly used endoscopic procedures such as bleeding ulcer stigmata and computed tomography of the brain for stroke localization and better than the physical diagnosis of heart sounds.     

Etiologic diagnosis of chronic osteomyelitis: a prospective study

BACKGROUND: Although bone specimens were established 25 years ago as the gold standard for etiologic diagnosis of chronic osteomyelitis, recent studies suggest that nonbone specimens are as accurate as bone to identify the causative agent. We examined concordance rates between cultures from nonbone and bone specimens in 100 patients. METHODS: Prospective study conducted at Hospital Universitario San Vicente de Paul, a 750-bed university-based hospital located in Medellín, Colombia. We included patients with chronic osteomyelitis who had been free of antibiotic therapy for at least 48 hours, excluding those with diabetic foot and decubitus ulcers. At least 1 nonbone and 1 bone specimen were taken from each individual and subjected to complete microbiologic analysis. RESULTS: Bone cultures allowed agent identification in 94% of cases, including anaerobic bacteria in 14%. Cultures of nonbone and bone specimens gave identical results in 30% of patients, with slightly better concordance in chronic osteomyelitis caused by Staphylococcus aureus (42%) than by all other bacterial species (22%). However, statistical concordance determined by the Cohen kappa statistic was less than 0 (-0.0092+/-0.0324), indicating that the observed concordance was no better than that expected by chance alone (P>.99). CONCLUSIONS: Appropriate diagnosis and therapy of chronic osteomyelitis require microbiologic cultures of the infected bone. Nonbone specimens are not valid for this purpose.     

Diagnostic performance of EUS for chronic pancreatitis: a comparison with histopathology

BACKGROUND: EUS has been proposed as a minimally invasive and accurate test to detect chronic pancreatitis (CP). OBJECTIVE: To investigate the correlation between EUS criteria and histopathology grading in patients with presumed CP. DESIGN: Retrospective study. SETTING AND PATIENTS: Patients who received pancreatic surgery according to presumed CP from the Medical University of South Carolina surgical database between 1995 and 2003 were identified and included if EUS was performed within 1 year before surgery. The number of EUS criteria for CP was compared with a histologic fibrosis score (FS). MAIN OUTCOME MEASUREMENTS: Sensitivity and specificity of number of EUS criteria compared with FS. RESULTS: Seventy-one patients were identified (38 women). Median FS was 7 (range, 0-12). Of the patients with calcifications: calcifications were detected by EUS in 30 (42%), 14 (47%) had calcifications missed by other imaging modalities, and 28 (93%) were confirmed to have abnormal histology (FS > or = 2). Of the patients without calcifications: in the 41 patients without calcifications on EUS, 36 (88%) had FS > or = 2; median FS was 5 (range, 0-12); the correlation between the number of EUS criteria and FS was low but statistically significant (r = 0.40; P = .01). Three or more EUS criteria provided the best balance of sensitivity (83.3%) and specificity (80.0%) for predicting abnormal histology. LIMITATIONS: Retrospective study. All patients were believed to need surgery. CONCLUSIONS: A threshold of 3 or more EUS criteria provides the best balance of sensitivity and specificity for histologic pancreatic fibrosis. Calcifications seen by EUS but missed by other imaging are common in this group of patients.     

Accuracy of endoscopic ultrasonography and magnetic resonance cholangiopancreatography for the diagnosis of chronic pancreatitis: a prospective comparison study

BACKGROUND: The diagnosis of chronic pancreatitis (CP) remains challenging. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) have been proposed as highly accurate diagnostic modalities. Although endoscopic retrograde cholangiopancreatography (ERCP) has been previously used as a gold standard, it is associated with a small but significant risk. We aim to compare the accuracy of EUS and MRCP with the composite gold standard using ERCP, surgical pathology, and/or long-term clinical follow-up. METHODS: Ninety-nine patients with clinical signs and/or symptoms suggestive of CP were prospectively enrolled. The diagnosis of CP by MRCP was established when one or more of these features were present: main duct dilation without obstruction, dilated side branches, intraductal stones, ductal irregularity, reduced T1-signal intensity, parenchymal atrophy, and reduced secretory response to secretin administration. The diagnosis of CP by EUS was made when 4 or more of the established criteria were present. Accuracy of all criteria used ("EUS only," "MRCP only," "either EUS or MRCP," and "both EUS and MRCP") was compared with the composite gold standard. RESULTS: Forty patients were diagnosed with CP by the composite gold standard whereas the remaining 59 patients were controls. EUS only seemed more sensitive but equally specific compared with MRCP only to diagnose CP. The combination of EUS and MRCP had a sensitivity of 98% for either EUS or MRCP and a specificity of 100% for both EUS and MRCP. CONCLUSIONS: EUS and MRCP are highly accurate modalities for the diagnosis of CP and are complementary when used together. If confirmed in larger series, the diagnosis of CP by both EUS and MRCP is highly predictive and ERCP is unlikely to add any useful information.     

Laparoscopy in chronic abdominal pain: a prospective nonrandomized long-term follow-up study

GOAL: Our aim was to assess the long-term efficacy of diagnostic laparoscopy and adhesiolysis on the treatment of intractable chronic abdominal pain. STUDY: This was a prospective nonrandomized study of 72 patients (60 women and 12 men). One surgeon performed a total of 79 diagnostic laparoscopies including 61 adhesiolysis. The patients' demographic data, operative findings, and long-term postoperative course were carefully recorded. A quality-of-life questionnaire was mailed after the mean follow-up of 3.7 years to find out the late course of any chronic abdominal symptoms after the surgery. RESULTS: Intra-abdominal adhesions were found in 61 patients (85%) in the laparoscopy, gynecologic disorders in 4, chronic appendicitis in 1, and no abnormality in 6 patients. The abdominal wall pain was a likely reason for pain in 12 patients (17%). The complication rate was minimal, including only four bleedings (one major), one perforation of urinary bladder, and three wound infections. At 1-month control, 38% of the patients were completely free of pain. In the long-term follow-up, chronic abdominal pain was totally healed in 33%, diminished in 46%, and unchanged in 21% of the patients. A total of 65 patients (90%) reported that the surgery had been beneficial for their intractable pain. CONCLUSIONS: By careful selection, for patients with chronic abdominal pain, laparoscopy alleviates the symptoms in more than 70% of the patients, and it should be considered if other diagnostics tests are negative. A placebo-controlled study is needed, in which the patients are randomized into laparoscopy and conservatively treated groups with a quality-of-life measurement.     

Endotherapy of early onset idiopathic chronic pancreatitis: results with long-term follow-up

BACKGROUND: Idiopathic chronic pancreatitis that presents at age 35 years or younger has been classified as early onset type and is often characterized by chronic severe pain. Endotherapy, with drainage of the main pancreatic duct, can lead to control of pain if ductal hypertension is an important cause. Long-term results of endotherapy in patients with early onset idiopathic chronic pancreatitis are reported herein. METHODS: This retrospective study consists of 11 patients (6 men, 5 women; mean age 24.2 years, range 16-34 years) treated endoscopically in a 6.5-year period. The indication for treatment was pain in all patients and all had a dilated main pancreatic duct on pancreatography. The objectives of endoscopic treatment were to obtain good drainage of the pancreatic duct and complete clearance of ductal stones. RESULTS: Treatment was successful in all patients with no procedure-related mortality and with mild complications. Seven patients remained free of pain relapses after a mean follow-up of 78.3 months (37-116 months). Seven relapses of pain were recorded in the remaining 4 patients. Endoscopic retreatment was successful in all cases. The difference between the number of hospitalizations during the year before treatment (mean 2.2, range 1-9) and the year after (mean 0.3, range 0-2) was statistically significant (p < 0.01). Statistical significance was maintained at 3 and 6 years' follow-up. CONCLUSIONS: Endoscopic treatment could be regarded as the initial management of choice for patients with early onset idiopathic chronic pancreatitis.     

Natural history of endocrine failure in tropical chronic pancreatitis: a longitudinal follow-up study

BACKGROUND AND AIMS: Diabetes in tropical chronic pancreatitis (TCP), also known as fibrocalculous pancreatic diabetes (FCPD), is frequently seen at diagnosis. The aim of the present study was to determine the natural history of endocrine failure in TCP subjects without diabetes at baseline. METHODS: Of 73 TCP subjects without diabetes according to World Health Organization (WHO) criteria at baseline who were seen at an out-patient center, 54 (74.0%) underwent periodic oral glucose tolerance tests on follow up. Another 54 sex-matched, non-diabetic subjects without chronic pancreatitis served as controls. Baseline demographic and clinical characteristics were noted. RESULTS: After a median follow up of 5.0 years in TCP subjects and 7.0 years in controls, 27 of 54 TCP subjects (50%) developed diabetes compared with 14 of 54 controls (25.9%). Of the TCP subjects, those who developed diabetes on follow up were older (31 +/- 12 vs 23 +/- 11 years; P = 0.013), had a higher body mass index (21.7 +/- 4.4 vs 18.2 +/- 3.5 kg/m2; P = 0.004), higher 2 h post-load plasma glucose (8.8 +/- 1.9 vs 6.7 +/- 1.4 mmol/L; P < 0.001) and lower fecal chymotrypsin (2.1 +/- 1.2 vs 4.3 +/- 2.5 U/g; P < 0.001) at baseline compared with those who did not develop diabetes. The median time for the development of diabetes after diagnosis of TCP was 9.6 years (compared with 14.4 years among controls). Only 2 of 13 TCP subjects (15.4%) who had undergone surgical interventions during the normal glucose tolerance phase developed diabetes during follow up. CONCLUSIONS: In TCP, there is progressive deterioration of endocrine pancreatic function, with development of diabetes in 50% of patients upon follow up, suggesting that FCPD is merely a later stage in the course of TCP. Early surgery may prevent the development of diabetes in TCP subjects.     

Endoscopic sonography in the diagnosis of chronic pancreatitis in the early stage

The author summarizes in the submitted review diagnostic possibilities of early stages of chronic pancreatitis. He evaluates from that aspect possibilities of common imaging methods (ultrasonography, computer tomography, endoscopic retrograde cholangiopancreatography) and endoscopic ultrasonography (EUS). Evaluation of the secretory exocrine capacity by means of the secretin-cerulein test. Although the method is demanding from the aspect of routine diagnosis, it is a method with comparable sensitivity and perhaps even greater specificity than ERCP. Other tests of exocrine pancreatic secretion are not sufficiently sensitive to be used for this diagnosis. Among imaging methods ERCP which is still considered the gold standard, evaluates even subtle changes in the efferent system. Endoscopic ultrasonography visualizes rather discrete changes of the parenchymatous structure, areas of fibrosis and oedema, or changes in the echogenicity of the duct wall. At present in the diagnosis of early stages of chronic pancreatitis most probably a combination of the method evaluating the exocrine secretory capacity of the pancreas and sensitive imaging methods (ERCP) will be most satisfactory. Further studies will show whether and when EUS could replace ERCP.     

EUS for detection of the hepatocellular carcinoma: results of a prospective study

BACKGROUND: Early detection of hepatocellular carcinoma (HCC) and accurate determination of the number of lesions are critical in determining eligibility for liver transplantation or resection. Current diagnostic modalities (CT and magnetic resonance imaging [MRI]) often miss small lesions. OBJECTIVE: To compare the accuracy of the EUS with CT for the detection of primary tumors of the liver. DESIGN: Prospective single-center study. SETTING: Academic medical center. PATIENTS: Subjects at high risk of HCC (hepatitis B, hepatitis C, or alcoholic cirrhosis) were enrolled. INTERVENTIONS: US, CT, MRI, and EUS examinations of the liver were performed. Liver lesions identified during EUS underwent EUS-guided FNA (EUS-FNA). RESULTS: Seventeen patients were enrolled in the study. Nine of these patients had liver tumors (HCC, 8; cholangiocarcinoma, 1). EUS-FNA established a tissue diagnosis in 8 of the 9 cases. The diagnostic accuracy of US, CT, MRI, and EUS/EUS-FNA were 38%, 69%, 92%, and 94%, respectively. EUS detected a significantly higher number of nodular lesions than US (P = .03), CT (P = .002), and MRI (P = .04). For HCC lesions, a trend was observed in favor of EUS for the detection of more lesions than US (8 vs 2; P = .06) and CT (20 vs 8; P = .06). No complications were observed as a result of EUS-FNA. LIMITATIONS: Small sample size. CONCLUSIONS: EUS-FNA is a safe and accurate test for the diagnosis of HCC. EUS increases the accuracy of intrahepatic staging of the HCC by delineation of lesions, which are missed by CT and MRI. We recommend EUS for suspected HCC, particularly in cases that are being considered for liver transplantation.     

Development of chronic airway obstruction in patients with eosinophilic bronchitis: a prospective follow-up study

STUDY OBJECTIVES: Eosinophilic bronchitis (EB) presents as a chronic cough and sputum eosinophilia without airflow limitation or bronchial hyperreactivity. Its long-term clinical course remains unknown. This study evaluated how frequently EB recurs and whether it develops chronic airway obstruction. DESIGN: This study was a prospective analysis. METHODS: Cough severity, FEV(1), provocative concentration of methacholine causing a 20% fall in FEV(1), and sputum eosinophil percentages were serially measured in 36 subjects for up to 48 months. All subjects inhaled corticosteroids until cough subsided. RESULTS: Five of the twenty four follow-up subjects (21%) had a recurrent episode of EB 4 to 6 months after disappearance of the first episode of EB (recurrent eosinophilic bronchitis). Progressive FEV(1) reduction > 20% was observed in three of the subjects, including a subject with asthma developing at the ninth month. Nineteen subjects had no recurrence of cough (nonrecurrent eosinophilic bronchitis) and no progressive FEV(1) reduction > 20%. However, sputum eosinophilia recurred between 4 months and 24 months in 10 subjects. Mean values of FEV(1) at the ninth and 12th months of the study were significantly lower in the recurrent eosinophilic bronchitis group than in the nonrecurrent eosinophilic bronchitis group (p < 0.01). CONCLUSION: These results suggest that repeated episode of EB is associated with the development of chronic airflow obstruction, including asthma.