Impact on Health-Related Quality of Life in Adults with Eosinophilic Gastritis and Gastroenteritis: A Qualitative Assessment

Background

Eosinophilic gastritis (EG) and eosinophilic gastroenteritis (EGE) are chronic immune-mediated conditions of the digestive tract, which affect the stomach only, or the stomach and small intestines, respectively. Though these disorders are uncommon, they are being increasingly recognized and diagnosed. While health-related quality of life (HRQOL) has been evaluated in other eosinophilic gastrointestinal diseases, this study is the first to describe HRQOL impacts unique to EG/EGE.

Aims

This study aims to qualitatively describe experiences of adults diagnosed with EG and EGE. We aim to identify impacts on HRQOL in this population in order to inform clinical care and assessment.

Methods

Seven patients diagnosed with EG or EGE participated in semi-structured interviews assessing common domains of HRQOL.

Results

Four distinct themes emerged from qualitative analyses, which represent impacts to HRQOL: the psychological impact of the diagnosis, impact on social relationships, financial impact, and impact on the body. These generally improved over time and with effective treatment.

Conclusions

This study demonstrated that patients with EG/EGE experience impacts to HRQOL, some of which differ from HRQOL of other eosinophilic gastrointestinal diseases. These results support the development of a disease-specific measure, or adaptation of an existing measure, to assess HRQOL in EG/EGE.

     

Cell-mediated cyclic thrombocytopenia treated with azathioprine

We studied a male patient with cyclic thrombocytopenia whose bone marrow megakaryocyte count showed cyclic fluctuations in synchrony with cyclic changes of platelet count. He failed to respond to either prednisolone or bolus methylprednisolone therapy, but subsequently he was successfully treated with azathioprine. To investigate the underlying pathogenesis of the cyclic fluctuations in the platelet count, we studied the kinetics of megakaryocyte progenitor cells (CFU-Meg) and the effects of the patient's peripheral blood mononuclear cells on CFU-Meg. In one cycle of the platelet fluctuation, the increase in the CFU-Meg number preceded an increase in the bone marrow megakaryocyte count and then the platelet count. In the latter half of the cycle, CFU-Meg, bone marrow megakaryocytes and platelets began to decrease in that order. Peripheral blood mononuclear cells obtained from the patient in the thrombocytopenic phase suppressed megakaryocyte colony formation from normal bone marrow cells in a dose-dependent manner. In contrast, these cells obtained in the phase of a normal platelet count did not suppress megakaryocyte colony formation at all. These findings indicate that the cause of platelet fluctuation is periodic failure of megakaryocytopoiesis at the stage of CFU-Meg and that the patient's peripheral mononuclear cells are responsible for periodically suppressing the CFU-Meg.     

In vivo effects of recombinant human interleukin-6 in primates: stimulated production of platelets

In cynomolgus monkeys, twice daily subcutaneous injections of recombinant human interleukin-6 (rhIL-6) at doses of 5 to 80 micrograms/kg/d for 14 consecutive days caused dose-dependent increases in platelet count, usually continuing for more than 1 week after cessation of the injections. The count reached a level approximately twofold or more above the preinjection level even at 5 micrograms/kg/d, and at doses of more than 20 micrograms/kg/d, the increase became biphasic with a higher second peak 3 days after cessation of the injections. Morphologic analysis of the bone marrow after the 7 day-injections with 80 micrograms/kg/d revealed a marked increment in size of megakaryocytes compared with control, indicating the promotion of megakaryocyte maturation. Other changes attributable to the rhIL-6 treatment include dose-dependent loss of body weight, anemia, neutrophilia and monocytosis, elevation of serum C-reactive protein and alpha-1 acid glycoprotein levels, and decrease of serum albumin; all of which returned to normal within 1 week after cessation of the injections and were tolerable at doses of less than 10 micrograms/kg/d. These findings suggest that rhIL-6 may be an effective strategy for the treatment of thrombocytopenia.     

Experimental studies of effects of acute renal venous congestion on renal function --with particular reference to renal arterio-venous plasma sodium difference.

Effects of acute renal venous congestion on renal function were studies. In anesthetized mongrels with intermittent or sustained elevation of the renal venous pressure produced experimentally by unilateral constriction of the renal vein, changes in renal function were investigated with the clearance method and plasma concentrations of electrolytes, protein and Ht of collected arterial and venous blood oals were divided into two groups according to the initial conditions concerning the various level of renal arterio-venous plasma sodium. In dogs (Group A) whose initial values of renal arterio-venous plasma sodium difference were not less than -1 mEq/L, the difference showed a negative tendency both during intermittent and during continuous congestion. In dogs (Group B) whose initial values of the difference were less than -1 mEq/L, the difference showed a positive tendency during renal venous congestion. (2) In dogs of Group A, i) the sodium reabsorption rate increased when renal physiological values (GFR and RPF) remained unchanged (during intermittent congestion) as well as when these values decreased (during continuous congestion). ii) The calculated "postglomerular" oncotic pressure and the sodium reabsorption rate were strongly correlated at the control period, showing a slightly less correlation during intermittent renal congestion, whereas during sustained congestion, the latter increased independently of the former. iii) The NCPF/CPAH remained unchanged or slightly increased during intermittent congestion and was remarkably elevated during sustained congestion. (3) In dogs of Group B, i) Diminution of renal functions such as GFR and RPF was prominent during renal congestin and satisfactory recovery of renal functions to the initial level did not occur even after release from congestion. ii) No significant increase of sodium reabsorption rate was obtained during continuous renal congestion. (4) The balance of sodium ion between the kidney and blood of dogs of Group A was discussed. The effects of acute renal venous congestion on renal function were divided into two groups and it was concluded that this renal arteriovenous plasma sodium difference is a most significant factor.