ASGE Weekend Endoscopy: Advances in the Diagnosis and Treatment of EoE

Video Transcription

Video Summary

This ASGE Weekend Endoscopy Live session focused on eosinophilic esophagitis (EOE), covering its rising prevalence, diagnosis, and management innovations. Experts noted a true increase in EOE cases in both adults and children, surpassing increased biopsy rates. Endoscopic evaluation using the EREF scoring system (evaluating edema, rings, exudates, furrows, and strictures) and multiple biopsies from proximal and distal esophagus are essential for diagnosis, given that endoscopic appearance can sometimes be normal. Barium swallow and EndoFLIP complement endoscopy for detecting strictures. Differentiating EOE from reflux can be challenging, especially when eosinophilia is patchy or borderline; clinical context and pathologist communication are crucial.<br /><br />Treatment is individualized, often starting with proton pump inhibitors (PPIs), then topical steroids, dietary elimination (typically six-food elimination focusing on milk, wheat, soy, egg, seafood, and nuts), or biologics like Dupilumab for severe or refractory cases. Allergy testing is limited in identifying triggers but helpful for managing comorbid allergies. Endoscopic dilation, mainly using Savary or balloon techniques, safely addresses strictures and is tailored by severity and patient symptoms.<br /><br />Long-term care involves regular clinical follow-up and repeat endoscopies every 1-2 years to monitor disease activity and prevent fibrosis. Newer approaches aim for personalized treatment and minimizing invasive procedures, enhancing quality of life in this increasingly recognized chronic disease.

Keywords

eosinophilic esophagitis

EOE prevalence

EREF scoring system

endoscopic evaluation

biopsy diagnosis

proton pump inhibitors

dietary elimination

endoscopic dilation

Dupilumab treatment