2023 Senior Fellows Program (2nd & 3rd Year) | August 2023-Lightdale_Nonevski

Lightdale_Nonevski_EoE lecture

Pdf Summary

Eosinophilic Esophagitis (EoE) is a chronic immune-mediated inflammatory condition of the esophagus. It is more common in males in their 3rd decade of life. The pathophysiology of EoE is related to genetics, allergies, and other environmental factors. Symptoms can vary depending on age, with dysphagia and food impaction being common in adults, while reflux, vomiting, abdominal pain, and failure to thrive are more common in children. Progressive fibrosis can occur with longer duration of disease, so early diagnosis and treatment are important. <br /><br />The diagnosis of EoE is made when patients have more than 15 eosinophils per high-power field (eos/hpf) on esophageal biopsies after failing proton pump inhibitor (PPI) therapy for 8 weeks. However, recent guidelines suggest discontinuing PPI therapy for 3 weeks before performing an esophagogastroduodenoscopy (EGD) with biopsies, as there is significant overlap between gastroesophageal reflux disease (GERD) and EoE.<br /><br />Treatment for EoE includes a variety of approaches. These can include dietary elimination, acid suppression with PPIs, topical corticosteroids, endoscopic dilation, and biologic therapy. It is important to note that up to 60% of treated EoE patients achieve long-term "deep" remission, but relapse rates are high, with only a small percentage able to discontinue therapy altogether.<br /><br />Overall, EoE is a complex condition that requires a multidisciplinary approach and individualized treatment plans based on the patient's symptoms, disease severity, and response to therapy. Ongoing research and advancements in biologic therapies offer hope for improved management of EoE in the future.

Keywords

Eosinophilic Esophagitis

chronic inflammation

genetics

allergies

dysphagia

fibrosis

proton pump inhibitor

esophageal biopsies

treatment approaches

biologic therapy