Okay, so let's go through the answers. I think you guys are going to get some of these right. Which food group is associated with the highest risk of esophageal eosinophilia? Is it A? Oh, look at that. We don't even have to go through this. Dairy. We drove that point home. Okay. What level of eosinophilia in esophageal is required? C. Greater than 15. An esophageal biopsy with a very high level of eosinophilia is always EOE or acid reflux disease or reflux esophagitis. False. All of the following are associated with a higher risk of EOE except residence in warmer climate, male sex, history of atopy, and early exposure of antibiotics. Excellent. What percentage of patients presenting with a food impaction have EOE? C. Mimi mentioned about 50% overall. All of the following are associated with esophageal eosinophilia except celiac disease, inflammatory bowel disease, gastroesophageal reflux disease, pill-induced esophagitis, or peptic ulcer disease? E. It's actually E, peptic ulcer disease. Okay. Eosinophilic esophagitis is associated with all of the following signs and symptoms except E, GI bleeding. It's not associated with that. It is associated with all the other symptoms that you see there as we've covered. Which of the following is the earliest compound released in the stimulation of esophageal eosinophilic inflammation following allergen exposure? TSLP. Excellent. Gary covered that thoroughly. Which of the following is not part of the three Ds of EOE treatment, diet, dilation drugs, or dysphagia? Dysphagia. D. It's not part of the treatment, it's a symptom. Which of the following is an acceptable first-line therapy for EOE? Is it H2 blockers, proton pump inhibitors, anti-TNF agents, or 5-aminosalicylates? B as in boy, proton pump inhibitors. Which of the following is an FDA-approved therapy for EOE? Is it proton pump inhibitors, oral budesonide suspension, fluticasone inhaler, or none of the above? None of the above. B. Excellent. What is the most common adverse event after endoscopic dilation? Is it chest pain, bleeding, perforation, or food impaction? A. Chest pain. Which of the following is true regarding EOE treatment? Control of inflammation reduces the need for endoscopic dilation, maintenance topical steroids should be avoided, H2 blockers improve esophageal eosinophilia, and allergy testing guided dietary restriction is more effective than the six-food elimination diet. Which of those is true? A. A. Good. Which of the following foods should be avoided in a two-food elimination diet in adults with EOE? Is it A. A. A. Excellent. Those are the two most common culprits. Which of the following regarding EOE is true? Once eosinophilia is controlled, relapse is rare after medications are discontinued, fibrostenotic strictures are more common when diagnosis is delayed, adolescents are more likely than adults to have strictures, and symptom resolution is a reliable indicator of improved esophageal inflammation. B. That's it. I think everybody got 100 percent, it sounds like. All right. So hopefully we've had enough time to collect our winners. I do have the opportunity, is Lance Leader here? Lance, you were the winner yesterday and we didn't get a chance to give you the grand prize and this is your grand prize. Congratulations. Thank you. Congratulations. Thank you. So while the judges are tabulating the results, a couple of housekeeping items that we need to do before we close and we have a few other announcements to make before we leave the room. But all of you have now successfully completed the ARIA curriculum that's customized for Santa Fe. You are hopefully now more well prepared to enter the field and engage with your healthcare professionals that you see on a daily basis and that's really our goal. But our goal here in the ARIA program is to improve this curriculum, improve the experience for professionals like yourself on an ongoing basis. So you will be receiving an evaluation of the course and we want your honest feedback so that we can continue to make this a great educational experience for attendees. You will receive that today. You will also be receiving the post-test, which was similar, identical to the pre-test that you all took and the goal is for you to achieve 80% correct. Once you achieve that 80% correct, you will then receive the ARIA seal, which is the ASGE logo. It's a brand new seal that we've just released this year and you'll be able to use that on your business cards and it will have the imprimatur of the ASGE obviously and really hopefully add some credibility to your interactions with your healthcare professionals. And we are in the process at ASGE of really marketing to our members and highlighting the benefits of ARIA, the ARIA program and completion of the ARIA program and individuals like yourself who have completed the ARIA program, what you bring to the game or the day-to-day operations of caring for patients with GI diseases. So we have our winners? Okay. And in addition, one last thing that you'll receive, and this will be about six to eight weeks later, we will be distributing an impact survey. Once you're in the field, whether you're sensing that this has really made a difference in your effectiveness and the confidence that you have in the field. So we ask that you please try to give us that feedback as the days and weeks go on. Okay. So as we get these loaded up, okay, we have our fifth place winner, Diego Martinez. Congratulations. So wow, 13,277 points. That's pretty impressive. Okay. In fourth place, we have Matt Hunting. Congratulations, Matt. Third place goes to Ida Kwan. Congratulations, Ida. And in fifth place goes to Tun Turv. All right, and our grand champion for this round of the knowledge check-in and recipient of the priceless ASGE swag is Dejarah Schmitz. All right, congratulations to all the winners and all the competitors. Thank you for your competition. We do have an additional input for all of those, all of you that have put on Post-Its up here and what your high points of learning were. And here we're going to kind of review some of them. You can see that folks really enjoyed the link between EOE and IBD. The villi are amazing, you know, that made an impression on someone. This just gives you an idea of some of the key points people took away. The goal of treatment is to really control inflammation and avoid complications. That's so important. What treat-to-target means, it's symptoms, histology, and improvement in endoscopy. All of those are very important. The esophagus is two to four millimeters thick, a very thin organ but carries a lot of potential for morbidity. Be sensitive to provider schedule. On the flip side, don't forget or let the provider feel like they are not forgotten between connections. So some important dynamics to take away from the day in the life of the gastroenterologist. There's some questions that came up and so we thought we'd have a chance to answer those. How often do you do biopsies during a normal colonoscopy? Only really if the patient has diarrhea or if you're doing surveillance for inflammatory bowel disease would we typically do, somebody that has known disease, would we typically do that in normal colonoscopy. If somebody's having a screening colonoscopy, we do not, unless there's an abnormality, do a biopsy. If there is removal of the small and large intestine, how much can you remove while still keeping the system viable or the patient alive, and how little intestine can you live with? It's a very good question and it varies from patient to patient but you'll probably need at least 60 centimeters of small intestine to really thrive without external intravenous nutrition support and those patients have what we call short gut syndrome and they have a lot of symptoms and a lot of complications. The colon you can live without and many people have a complete colectomy but the small intestine you cannot live without the entirety of the small intestine. In the absence of H. pylori and also what else causes gastritis, assuming no alcohol or medications, well there's Crohn's disease can cause gastritis, there's a lot of immune mediated inflammations of the stomach but by far and away H. pylori is the most common cause of a chronic histologic gastritis. We often use the term gastritis with NSAIDs or non-steroidal anti-inflammatory agents but it's not usually a chronic gastritis, it's really more of an acute erosions that you see with those. Here you can see some of the other very important learning points that people took away creating a community of EOE patients. We learned that from our patient that we had the interview with today in the breakout sessions that there's a need for patients to connect with each other and really learn from each other. Here's again some thoughts about immunotherapy may exact cause or exacerbate EOE was something we learned. The significance of impacted food is a big deal, you know, Gary touched on this yesterday, our patient touched on this when we spoke with him earlier today. It can lead to lung aspirations and the fear of dying and you can saw our patient really has a fear of dying from this condition. Here's some other great takeaway points, IBS versus IBD is fascinating. Know your audience when you go into the offense, know who you're speaking to, know what the dynamic is, know who people are, their personnel, et cetera. Okay. These are really the winners of our top tips or learning nugget winners and you will also be receiving prizes so we'll be calling you down for winners. Those of you that provided these obviously recognize them. So a challenge we face in the field is the fact that many healthcare providers consider successful management of EOE to be when patients express improvement in symptoms versus symptomatic histologic and endoscopic improvements. Oh, we're going to the bottom, I'm sorry. So coordination of care involves GI allergist, pathologist, and dieticians, co-management and quality of life is important and that goes to Carrie Cotillo, Carrie? Thank you. You're welcome. Congratulations. Okay, the next learning nugget was asking about dysphagia alone is not enough. Really have to go to deeper level with what the patients are eating because they may adapt and learn to adapt to their foods so they don't experience dysphagia and that winner is Belinda Edlin. You're welcome. And finally our top learning nugget winner again was the challenge we face in the field is the fact that many healthcare providers consider successful management of just improving in symptoms as opposed to the treat the target and the winner is TM. Who's TM? There we go. Congratulations. Thank you. Appreciate it. One little thing about our leaders, they're the best in the area. We need a different size cell for the people in the middle. Okay, a lot of people to thank. First I want to obviously thank our ASG staff that did mountains of work behind the scenes to put this course on including Ed and Michelle and Lyle. Lots and lots of planning went into this, communication with your leaders about creating the curriculum and creating this experience for you. I and the faculty could not do it without you so thank you to all of the ASG staff that put this together. Secondly, the faculty that joined us for this curriculum, the diversity of the experience of the practice settings, their expertise was just remarkable. I learned a lot from listening to a lot of their lectures and conversations and I am indebted to their expert performance as faculty for this course so thank you so much. Next I'd like to thank the Santa Fe leaders who made the choice to put you guys through this program. They invested in you, they created the opportunity for this to happen and it was with their vision that this program happened so thank you to them. And last but certainly not least, thank you to you for taking the time out of your personal lives. I know you may not have a choice, your boss has probably made the choice. But taking the time out of your business and the people you call on to come here to the ASGE IT&T Center, experience this program, build relationships with your colleagues, and hopefully put you in a better position to be successful in your career. So thank you so much for investing the time and we look forward to seeing the success that you guys achieve. Tony wanted an opportunity to address you guys before we all break so Tony, the floor is yours. Thank you. What did you guys think? Yes! Absolutely. So I won't go through all the thank you's again, with maybe just a few exceptions. So also, don't forget about Lauren and Jimmy B with the training team and Anca with medical. That was months of, and Ed in the back, that was months of contracting work to make sure we could have the partnership. But I do want to circle back to one, two particular thank you's. I saw you, I mean hours, hours of content on the board, I mean how many notebooks are practically filled? I mean I saw some of you using a second notebook to continue to take notes. So really I love the determination and the focus. We're not really good about sitting in chairs and you're usually out and about every day so it really says a lot. And why it says so much, you know, this faculty is not only investing in you, we saw many of them at DDW. I mean they are investing in this overall disease in everything they do. The institutions that they're a part of, their colleagues, many of which are friends, but also industry as well. So I think we need to give one more extremely loud and proud round of applause to our faculty. Being all sincere, we can't thank you enough. It will make us better. And I think most importantly, and I think we heard it from a lot of you during the discussion, it really comes down to how do we continue to partner together to help the patient and to have that impact. And at the end of the day, if we can better understand our physicians, what they face, how they're treating the disease, the procedures in which they're performing, whether or not Dupixent is the right answer or not, I don't even mean it like that, it's ultimately how do we help these patients and whatever that means, we are grateful for that. So last thing, and then I'll sit down and let you do your thing, is tonight we'll have a team building. We'll have some fun. So dress casual. We'll have a good time. We will have a little game. You'll receive a little nine box grid with the goal of finding at least from every region a fun fact about at least one person from every region. And the first person that gets to myself or Sheldon, the first three people that turn in their card with all nine, well, we have a little something something points related for you. So again, we want to continue to get to know each other, having this opportunity here live together, so some fun times tonight. But with that, Dr. Tierney, thank you so much. You're my last thank you for moderating and putting up with us for two days. Thank you very much. Thank you. You guys were a joy and enjoy the rest of your week here in the Downers Grove and Oak Brook area and the rest of your meeting. We look forward to seeing you down the road.

ARIA

esophageal eosinophilia

treatment

food group

eosinophilia diagnosis

symptoms