Alex Straumann

Universitätsspital Basel, Bâle, Basel-City, Switzerland

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Publications (137)1049.01 Total impact

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    ABSTRACT: Monitoring of the treatment response in eosinophilic oesophagitis (EoE) requires structured endoscopical and histological examination of the oesophagus. Less invasive methods would be highly desirable. To evaluate the utility of several EoE-associated blood and serum markers in order to non-invasively monitor the response to treatment with swallowed topical corticosteroids in adult EoE patients. In a randomised, controlled double-blind trial blood samples of EoE patients (n = 69) were collected at baseline and after 14 days of treatment with budesonide (n = 51) or placebo (n = 18) respectively. Absolute blood eosinophil count (AEC) as well as serum levels of CCL-17, CCL-18, CCL-26, eosinophil-cationic-protein (ECP) and mast cell tryptase (MCT) were determined and correlated with oesophageal eosinophil density and with symptom and endoscopy scores. Histological remission, defined as mean number of <16 eos/mm(2) hpf at end-of-treatment, was achieved in 98% of the budesonide and 0% of the placebo recipients. AEC [380.2 vs. 214.7/mm(3) (P = 0.0001)], serum-CCL-17 [294.3 vs. 257.9 pg/mL (P = 0.0019)], -CCL-26 [26.7 vs. 16.2 pg/mL (P = 0.0058)], -ECP [45.5 ± 44.7 vs. 27.5 ± 25.0 μg/L (P = 0.0016)] and -MCT [5.3 ± 2.9 vs. 4.5 ± 2.6 μg/L (P = 0.0019)] significantly decreased under budesonide but not under placebo. AEC significantly correlated with oesophageal eosinophil density before (r = 0.28, P = 0.0236) and after (r = 0.42, P = 0.0004) budesonide treatment. In ROC-AUC analyses post-treatment values of AEC were significantly associated with histological remission (ROC-AUC 0.754; 95% CI: 0.617-0.891; P = 0.0003). The budesonide-induced treatment response in EoE is mirrored by several blood and serum markers, and the absolute blood eosinophil count is the most valuable as it shows correlation with the oesophageal eosinophil density. © 2015 John Wiley & Sons Ltd.
    Alimentary Pharmacology & Therapeutics 08/2015; DOI:10.1111/apt.13386 · 4.55 Impact Factor
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    ABSTRACT: Knowledge about determinants of quality of life (QoL) in eosinophilic oesophagitis (EoO) patients helps to identify patients at risk of experiencing poor QoL and to tailor therapeutic interventions accordingly. To evaluate the impact of symptom severity, endoscopic and histological activity on EoE-specific QoL in adult EoE patients. Ninety-eight adult EoE patients were prospectively included (64% male, median age 39 years). Patients completed two validated instruments to assess EoE-specific QoL (EoO-QoL-A) and symptom severity (adult EoE activity index patient-reported outcome) and then underwent esophagogastroduodenoscopy with biopsy sampling. Physicians reported standardised information on EoE-associated endoscopic and histological alterations. The Spearman's rank correlation coefficient was calculated to determine the relationship between QoL and symptom severity. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms, endoscopic and histological findings explain variations in QoL. Quality of life strongly correlated with symptom severity (r = 0.610, P < 0.001). While the variation in severity of symptoms, endoscopic and histological findings alone explained 38%, 35% and 22% of the variability in EoE-related QoL, respectively, these together explained 60% of variation. Symptom severity explained 18-35% of the variation in each of the five QoL subscale scores. Eosinophilic oesophagitis symptom severity and biological disease activity determine QoL in adult patients with eosinophilic oesophagitis. Therefore, reduction in both eosinophilic oesophagitis symptoms as well as biological disease activity is essential for improvement of QoL in adult patients. number, NCT00939263. © 2015 John Wiley & Sons Ltd.
    Alimentary Pharmacology & Therapeutics 08/2015; DOI:10.1111/apt.13370 · 4.55 Impact Factor
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    ABSTRACT: Background Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus with a rapidly increasing incidence. However, population-based epidemiologic data on EoE are rare and limited to regions with less than 200,000 inhabitants. We evaluated the incidence and prevalence of EoE over time in Canton of Vaud, Switzerland.Materials and methodsCanton of Vaud lies in the French-speaking, Western part of Switzerland. As of 12/2013, it had a population of 743,317 inhabitants. We contacted all Pathology institutes (n=6) in this canton in order to identify patients that have been diagnosed with esophageal eosinophilia between 1993 and 2013. We then performed a chart review in all adult and pediatric gastroenterology practices to identify EoE patients.ResultsOut of 263 patients with esophageal eosinophilia, a total of 179 fulfilled the diagnostic criteria for EoE. Median diagnostic delay was 4 (IQR 1-9) years. No patient was diagnosed with EoE prior to 2003. Incidence of EoE increased from 0.16/100,000 inhabitants in 2004 to 6.3/100,000 inhabitants in 2013 (p<0.001). The cumulative EoE prevalence in 2013 was 24.1/100,000. The incidence in males was 2.8 times higher (95%-CI 2.01-3.88, p<0.001) when compared to that in females. The annual EoE incidence was 10.6 times higher (95%-CI 7.61-14.87, p<0.001) in the period from 2010–2013 when compared to that in the period from 1993–2009. Conclusions: The incidence and cumulative prevalence of EoE in Canton of Vaud, Switzerland, has rapidly increased in the past ten years.This article is protected by copyright. All rights reserved.
    Allergy 08/2015; DOI:10.1111/all.12733 · 6.00 Impact Factor
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    ABSTRACT: Background The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown.AimTo assess whether ‘early treatment’ with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to ‘late treatment’, which was defined as treatment initiation after >2 years from the time of CD diagnosis.Methods Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications.ResultsThe ‘early treatment’ group of 292 CD patients was compared to the ‘late treatment’ group of 248 CD patients. We found that ‘early treatment’ with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, ‘early treatment’ with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006).Conclusions Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication.
    Alimentary Pharmacology & Therapeutics 08/2015; DOI:10.1111/apt.13363 · 4.55 Impact Factor
  • A Schoepfer · E Safroneeva · A Straumann
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    ABSTRACT: Activity of Eosinophilic Esophagitis (EoE) can be measured by patient reported outcomes (symptoms and quality of life) and clinician-reported outcomes (endoscopic, histologic, or biochemical alterations). Over the last years efforts have been underway to develop and validate instruments to assess EoE activity in the different domains. Such instruments are urgently needed to standardize the language of EoE activity assessment and, in so doing, to facilitate communication among various stakeholders. Such standardization will ultimately allow EoE researchers to define meaningful endpoints for use in clinical trials and observational studies, to compare the efficacy of different therapeutic modalities, and to develop algorithms in order to provide patients with the appropriate therapy. This review provides an overview of the current status of instruments that assess EoE activity in the different domains. © 2015 International Society for Diseases of the Esophagus.
    Diseases of the Esophagus 07/2015; DOI:10.1111/dote.12391 · 2.06 Impact Factor
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    ABSTRACT: Studies that systematically assess change in ulcerative colitis (UC) extent over time in adult patients are scarce. To assess changes in disease extent over time and to evaluate clinical parameters associated with this change. Data from the Swiss IBD cohort study were analysed. We used logistic regression modelling to identify factors associated with a change in disease extent. A total of 918 UC patients (45.3% females) were included. At diagnosis, UC patients presented with the following disease extent: proctitis [199 patients (21.7%)], left-sided colitis [338 patients (36.8%)] and extensive colitis/pancolitis [381 (41.5%)]. During a median disease duration of 9 [4-16] years, progression and regression was documented in 145 patients (15.8%) and 149 patients (16.2%) respectively. In addition, 624 patients (68.0%) had a stable disease extent. The following factors were identified to be associated with disease progression: treatment with systemic glucocorticoids [odds ratio (OR) 1.704, P = 0.025] and calcineurin inhibitors (OR: 2.716, P = 0.005). No specific factors were found to be associated with disease regression. Over a median disease duration of 9 [4-16] years, about two-thirds of UC patients maintained the initial disease extent; the remaining one-third had experienced either progression or regression of the disease extent. © 2015 John Wiley & Sons Ltd.
    Alimentary Pharmacology & Therapeutics 07/2015; DOI:10.1111/apt.13307 · 4.55 Impact Factor
  • Source
    Alex Straumann · Ekaterina Safroneeva
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    ABSTRACT: Eosinophilic esophagitis (EoE) is an immune-mediated, chronic inflammatory disease of the esophagus. If left untreated, eosinophilic inflammation induces esophageal remodeling with fibrosis and stricture formation, and patients are permanently at risk of experiencing food impactions. Therefore, it is widely accepted that active EoE should be treated. An ideal EoE therapy should achieve two therapeutic goals: first, to resolve symptoms and, second, to control inflammation. Avoidance of food allergens by the means of food elimination diets as well as anti-inflammatory drugs has the ability to achieve both of these goals. Among the pharmacologic options, only corticosteroids have documented efficacy, whereas alternatives have shown rather disappointing results or are still under evaluation. Swallowed topical corticosteroids (TCS) are at least as efficient as systemically administered corticosteroids (SCS) and have fewer side effects. As such, TCS are widely used as a first-line drug in the treatment of EoE, even though this compound is not approved for this indication by regulatory authorities. Unfortunately, the therapeutic goals cannot be achieved in approximately 30 % of EoE patients, despite appropriate treatment with corticosteroids. For this “difficult-to-treat” patient category, therapeutic alternatives are urgently needed. Key points 1. Clinically and histologically active eosinophilic esophagitis must be treated, even when patients effectively cope with their symptoms. 2. Swallowed topical corticosteroids have proven efficacy, a good safety profile and are currently used as a first-line pharmacologic treatment of eosinophilic esophagitis. 3. Eosinophilic esophagitis is a chronic disease; as such, a long-term follow-up and therapeutic strategy is needed.
    06/2015; 2(2). DOI:10.1007/s40521-015-0048-y
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    ABSTRACT: Data evaluating the chronological order of appearance of extraintestinal manifestations (EIMs) relative to the time of inflammatory bowel disease (IBD) diagnosis is currently lacking. We aimed to assess the type, frequency, and chronological order of appearance of EIMs in patients with IBD. Data from the Swiss Inflammatory Bowel Disease Cohort Study were analyzed. The data on 1249 patients were analyzed (49.8% female, median age: 40 [interquartile range, 30-51 yr], 735 [58.8%] with Crohn's disease, 483 [38.7%] with ulcerative colitis, and 31 [2.5%] with indeterminate colitis). A total of 366 patients presented with EIMs (29.3%). Of those, 63.4% presented with 1, 26.5% with 2, 4.9% with 3, 2.5% with 4, and 2.7% with 5 EIMs during their lifetime. Patients presented with the following diseases as first EIMs: peripheral arthritis 70.0%, aphthous stomatitis 21.6%, axial arthropathy/ankylosing spondylitis 16.4%, uveitis 13.7%, erythema nodosum 12.6%, primary sclerosing cholangitis 6.6%, pyoderma gangrenosum 4.9%, and psoriasis 2.7%. In 25.8% of cases, patients presented with their first EIM before IBD was diagnosed (median time 5 mo before IBD diagnosis: range, 0-25 mo), and in 74.2% of cases, the first EIM manifested itself after IBD diagnosis (median: 92 mo; range, 29-183 mo). In one quarter of patients with IBD, EIMs appeared before the time of IBD diagnosis. Occurrence of EIMs should prompt physicians to look for potential underlying IBD.
    Inflammatory Bowel Diseases 05/2015; DOI:10.1097/MIB.0000000000000429 · 5.48 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-30. DOI:10.1016/S0016-5085(15)30104-9 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-868. DOI:10.1016/S0016-5085(15)32943-7 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-791. DOI:10.1016/S0016-5085(15)32702-5 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-414. DOI:10.1016/S0016-5085(15)31391-3 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-415. DOI:10.1016/S0016-5085(15)31395-0 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-458-S-459. DOI:10.1016/S0016-5085(15)31546-8 · 13.93 Impact Factor
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    ABSTRACT: Physicians traditionally treat ulcerative colitis (UC) using a step-up approach. Given the paucity of data, we aimed to assess the cumulative probability of UC-related need for step-up therapy and to identify escalation-associated risk factors. Patients with UC enrolled into the Swiss IBD Cohort Study were analyzed. The following steps from the bottom to the top of the therapeutic pyramid were examined: (1) 5-aminosalicylic acid and/or rectal corticosteroids, (2) systemic corticosteroids, (3) immunomodulators (IM) (azathioprine, 6-mercaptopurine, methotrexate), (4) TNF antagonists, (5) calcineurin inhibitors, and (6) colectomy. Data on 996 patients with UC with a median disease duration of 9 years were examined. The point estimates of cumulative use of different treatments at years 1, 5, 10, and 20 after UC diagnosis were 91%, 96%, 96%, and 97%, respectively, for 5-ASA and/or rectal corticosteroids, 63%, 69%, 72%, and 79%, respectively, for systemic corticosteroids, 43%, 57%, 59%, and 64%, respectively, for IM, 15%, 28%, and 35% (up to year 10 only), respectively, for TNF antagonists, 5%, 9%, 11%, and 12%, respectively, for calcineurin inhibitors, 1%, 5%, 9%, and 18%, respectively, for colectomy. The presence of extraintestinal manifestations and extended disease location (at least left-sided colitis) were identified as risk factors for step-up in therapy with systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and surgery. Cigarette smoking at diagnosis was protective against surgery. The presence of extraintestinal manifestations, left-sided colitis, and extensive colitis/pancolitis at the time of diagnosis were associated with use of systemic corticosteroids, IM, TNF antagonists, calcineurin inhibitors, and colectomy during the disease course.
    Inflammatory Bowel Diseases 03/2015; 21(6). DOI:10.1097/MIB.0000000000000368 · 5.48 Impact Factor
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    ABSTRACT: To investigate the efficacy and safety of two different budesonide formulations (effervescent tablet for orodispersible use (BET) and viscous suspension (BVS)) with different daily dosages for short-term treatment of eosinophilic oesophagitis (EoE). Adults with active EoE (n=76) randomly received 14 days' treatment with either BET 2×1 mg/day (BET1, n=19) or BET 2×2 mg/day (BET2, n=19), or BVS 2×5 mL (0.4 mg/mL)/day (BVS, n=19) or placebo (n=19) in a double-blind, double-dummy fashion, with a 2-week follow-up. Primary end point was histological remission (mean of <16 eosinophils/mm(2 )hpf). Secondary end points included endoscopy score, dysphagia score, drug safety and patient's preference for drug formulation. Histological remission occurred in 100%, 94.7% and 94.7% of budesonide (BET1, BET2, BVS, respectively) and in 0% of placebo recipients (p<0.0001). The improvement in total endoscopic intensity score was significantly higher in the three budesonide groups compared with placebo. Dysphagia improved in all groups at the end of treatment; however, improvement of dysphagia persisted only in those treated with BET1 (p=0.0196 vs placebo). There were no serious adverse events. Local fungal infection (stained fungi) occurred in two patients of each budesonide group (10.5%). The effervescent tablet was preferred by 80% of patients. BET or BVS was highly effective and safe for short-term treatment of EoE. The 1 mg (twice daily) dosage was equally effective as the 2 mg twice daily dosage. The majority of patients preferred the effervescent tablet formulation. NCT02280616; EudraCT number, 2009-016692-29. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Gut 03/2015; DOI:10.1136/gutjnl-2014-308815 · 13.32 Impact Factor
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    ABSTRACT: There is no "gold standard" for assessing disease activity in patients with eosinophilic esophagitis (EoE). We aimed to compare physicians' judgment of EoE activity with patients' judgment of symptom severity. We also aimed to examine the relative contribution of symptoms as well as endoscopic and histologic findings in shaping physicians' judgment of EoE activity. Six gastroenterologists (all EoE experts) assessed EoE-associated symptoms in adult patients. Patients completed a symptom instrument and provided global assessment of EoE symptom severity (PatGA) (Likert scale: 0 (inactive) to 10 (most active)). Following esophagogastroduodenoscopy with biopsy sampling, gastroenterologists provided a global assessment of EoE activity (PhysGA) (Likert scale from 0 to 10) based on patient history and endoscopic and histologic findings. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms and endoscopic and histologic findings explain variations in PhysGA. A total of 149 EoE patients were prospectively included (71.8% male, median age at inclusion 38 years, 71.8% with concomitant allergies). A moderate positive correlation between PhysGA and PatGA (rho=0.442, P<0.001) was observed and the mean difference in the Bland-Altman plot was 1.77. Variations in severity of endoscopic findings, symptoms, and histologic findings alone explained 53%, 49%, and 30%, of the variability in PhysGA, respectively. Together, these findings explained 75% of variability in PhysGA. Gastroenterologists rate EoE activity mainly on the basis of endoscopic findings and symptoms and, to a lesser extent, on histologic findings.
    Gastroenterology 03/2015; 110(3):402-14. DOI:10.1038/ajg.2015.32 · 13.93 Impact Factor
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    ABSTRACT: Background Eosinophilic esophagitis (EoE) exhibits esophageal dysfunction owing to an eosinophil-predominant inflammation. Activated eosinophils generate eosinophil extracellular traps (EETs) able to kill bacteria. There is evidence of an impaired barrier function in EoE that might allow pathogens to invade the esophagus. This study aimed to investigate the presence and distribution of EETs in esophageal tissues from EoE patients and their association with possible epithelial barrier defects.Methods Anonymized tissue samples from 18 patients with active EoE were analyzed. The presence of DNA nets associated with eosinophil granule proteins forming EETs and the expression of filaggrin, the protease inhibitor lympho-epithelial Kazal-type-related inhibitor (LEKTI), antimicrobial peptides, and cytokines were evaluated by confocal microscopy following immune fluorescence staining techniques.ResultsEET formation occurred frequently and was detected in all EoE samples correlating with the numbers of infiltrating eosinophils. While the expression of both filaggrin and LEKTI was reduced, epithelial antimicrobial peptides (human beta-defensins-2, -3, cathelicidin LL-37, psoriasin) and cytokines (TSLP, IL-25, IL-32, IL-33) were elevated in EoE as compared to normal esophageal tissues. There was a significant correlation between EET formation and TSLP expression (p=0.02) as well as psoriasin expression (p=0.016). On the other hand, a significant negative correlation was found between EET formation and LEKTI expression (p=0.016).Conclusion Active EoE exhibits the presence of EETs. Indications of epithelial barrier defects in association with epithelial cytokines are also present which may have contributed to the activation of eosinophils. The formation of EETs could serve as a firewall against the invasion of pathogens.This article is protected by copyright. All rights reserved.
    Allergy 01/2015; 70(4). DOI:10.1111/all.12570 · 6.00 Impact Factor
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    ABSTRACT: BACKGROUND: Eosinophilic esophagitis is a chronic-inflammatory immune-mediated disease of the esophagus. The most common symptoms of eosinophilic esophagitis are dysphagia for solids and bolus obstruction. Approximately half of the patients complain about spontaneously occurring chest pain. However, some patients with eosinophilic esophagitis suffer from, in addition to the described symptoms, exercise-induced chest pain. METHODS AND RESULTS: Here we report on several patients presenting with exercise-induced chest pain, with 2 patients presenting exclusively only with this symptom. After a comprehensive evaluation including exclusion of gastroesophageal reflux disease and heart disease, a diagnosis of eosinophilic esophagitis based on endoscopical and histological criteria was unequivocally established. The condition improved rapidly after initiation of a treatment with topical corticosteroids. CONCLUSION: Eosinophilic esophagitis should be considered in the differential diagnosis in patients presenting with exercise-induced chest pain, particularly in younger male individuals.
    The American Journal of Medicine 09/2014; 128(2). DOI:10.1016/j.amjmed.2014.08.007 · 5.30 Impact Factor
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    ABSTRACT: & Aims: Standardized instruments are needed to assess the activity of eosinophilic esophagitis (EoE), to provide endpoints for clinical trials and observational studies. We aimed to develop and validate a patient-reported outcome (PRO) instrument and score, based on items that could account for variations in patients' assessments of disease severity. We also evaluated relationships between patients' assessment of disease severity and EoE-associated endoscopic, histologic, and laboratory findings.
    Gastroenterology 08/2014; 147(6). DOI:10.1053/j.gastro.2014.08.028 · 13.93 Impact Factor

Publication Stats

5k Citations
1,049.01 Total Impact Points


  • 2006–2015
    • Universitätsspital Basel
      Bâle, Basel-City, Switzerland
    • University Hospital of Lausanne
      • Service de gastro-entérologie et d'hépatologie
      Lausanne, VD, Switzerland
  • 2013
    • Viollier AG
      Bâle, Basel-City, Switzerland
  • 2012
    • Universität Basel
      Bâle, Basel-City, Switzerland
  • 2010–2012
    • Universität Bern
      • • Institute of Social and Preventive Medicine
      • • Institut für Pharmakologie
      • • Institute of Animal Pathology
      Berna, Bern, Switzerland
  • 2011
    • The Children's Hospital of Philadelphia
      Filadelfia, Pennsylvania, United States
  • 2007
    • Riley Hospital for Children
      Indianapolis, Indiana, United States