Okay, so here are the day two takeaway points that were collected and summated from our board. Eos count in the colon will change with the seasons. Found it interesting of the high rates with identical twins both having EoE of 41 percent and a lower rate of siblings, 2.4 percent. Long-standing disease, impact visible and laminar-appropriate, comments on tissue variability. The role of APPs is dispensable in GI practice. Yeah, did I say dispensable? The role of APPs is indispensable in, I suppose that's basically GI esophageal practice. Follow-up treatment and explanation, easy access to APPs for patients. Prolonged delay diagnosed today, I love that. Great rates of strictures and progressive fibrosis occur, greater rates of strictures and fibrosis occur with longer duration of disease. Take the biopsy at the time of food impaction, over 50 percent of patients with food impaction have EoE. Takeaway points include EoE diagnostic delay impacts fibrostatic progression 47 to 80 percent. EoE was reported in 1977, 46 years ago, and biologic trials started in 2015, 38 years from the first reports. EoE in twins, 22 percent dizygotic twin rate as twins with ATP condition, this is interesting to me. Diagnostic delay and fibrostenosis result in four studies, more strictures increased 9 percent per year undiagnosed. So, again, it all relates to early diagnosis and early intervention. And that's not always easy, as our patient said, it was almost a year before, after his food impaction that he had his EGD. EoE is heterogeneous, eosinophils on microscopy stain are pink and sparkly. Interesting takeaways, prevalence of fibrotic features increased from 47 percent diagnostic delay of two years to 88 percent if the diagnosis is delayed greater than 20 years. There's a variability of biopsies within clinical context, degranulation of eosinophils, basal cell hyperplasia, no EOs in mucosa, quality of endoscopy, and clinical considerations all lead to the diagnosis. It's not enough to just ask your patients, do you have difficulty swallowing? So it's important to probe. Eosinophils on microscopy stain are pink and sparkly. I think the sparkly word caught everybody's attention. It's key to separate biopsies by location, distal or proximal, into separate jars for the pathologist to analyze. You can dilate safely following food impaction. It says you can dilate safely following food impaction removal. Usually we don't dilate safely, we usually biopsy, but not do dilation. Okay, you should biopsy after food impaction, but you should not dilate. There you go, that's a follow-up. Shared decision with APP is still a challenge. Understand who makes the decision in the office. Too many key takeaways to express, excellent, informative, and appreciated. Every 10 years of increase in age, odds of fibrosis doubles. Hashtag respect my prescription. Again, that was borrowed from my colleague in Oklahoma City who is an IBD doctor. Do not count degranulated EOs in biopsies. EO count varies seasonally in the colon. Education programs would be related to closing gap in knowledge on treating and managing diagnosis of EOE. Focus on community GI, APP, and primary care docs. Reflux and EOE are similar, therefore multiple passes in location are key, because that means biopsies. And more important to ask how they're eating versus issues with swallowing. Again, that comes back up. Dr. Martin's perception of APPs and their contribution to patient care is refreshing and enduring. When suspecting EOE, it is not enough to only ask about difficulty swallowing when assessing symptoms. Many patients will say they do not have dysphagia because they have adapted their behaviors. And again, that's come up over and over and over again, and we really need to educate our clinicians about that. Less than 1% chance of perforation with EOE during dilation. Burnout term means more severe disease, not a HSP is, quote-unquote, burned out. With fibrosis, we should not turn on and turn off inflammation. Interesting conversation around when to biopsy, should it be done at the time of food impaction or upon follow-up. And again, we should really focus on trying to biopsy at the time of food impaction. Patients have adapted behaviors that mask symptoms very important for providers to probe, ask more specific questions, and transnasal endoscopy is in the future, allowing HSPs to diagnose on the spot. All right. And we have four winners of the takeaway of the day. And our first winner. goes to Bill Browning for. Bill gets an award because not only did he leave a message that EOE is heterogeneous, but he left some artwork, and I assume that's all the EOs he was counting on the slide. Two Bills. And second place, Kristen B., less than 1% chance of perforation with EOE and dilation. EOE was reported in 1977, 46 years ago. As twins with atopic condition, this is interesting to me. So come on down, Kristen. Good job. There you go. Thank you. I appreciate it. Gotcha. Thanks so much. You bet. Thank you. All right. Next winner is Katie Schuller with fibrosis. We should not turn on and off inflation. Every 10 years of age, odds of fibrosis doubles and hashtag respect my prescription. Appreciate that. Thank you. You're welcome. All right. And last but not least, Mark Carlisle. It's a key to separate biopsies by location, distal, and proximal into separate jars. Congratulations. Thank you. Thank you. Excellent. All right. So our knowledge challenge, we have two weeks. winners. Our second place winner is Kelly Sparacino with 10,649 points. Kelly, it's because she was at my table. And our grand champion for today is Yulia Erechman. That's not fair.

eosinophilic esophagitis

Eos count variations

identical twins and EOE

early diagnosis and intervention

fibrotic features and diagnostic delays