Advanced Practice Provider EoE Program (Live/Virtual) | November 2024-Highway to the Danger Zone

Pdf Summary

The document outlines the complexities involved in diagnosing and managing esophageal strictures, focusing on the significant role of Advanced Practice Providers (APPs) in these processes. The case study presented is of a 36-year-old male experiencing recurrent food impaction, eventually diagnosed via an Esophagogastroduodenoscopy (EGD) that revealed indicators of Eosinophilic Esophagitis (EOE). Key symptoms of esophageal strictures include difficulty swallowing, chest pain when eating, and weight loss. The document emphasizes that up to 50% of food impactions can be attributed to EOE, which progresses from inflammation to fibrosis over time. <br /><br />Initial management in the case involved starting the patient on a twice-daily Proton Pump Inhibitor (PPI) and topical corticosteroids, leading to symptom improvement. The ASGE (American Society for Gastrointestinal Endoscopy) stresses that endoscopy and biopsy, rather than symptoms alone, are crucial for assessing EOE activity before changing dietary or pharmacological treatments. <br /><br />The text describes standard treatment practices for EOE, including elimination diets and use of medications like topical steroids and dupilumab. It underscores the importance of collaboration between APPs and GI physicians, especially when managing more complex cases. Esophageal dilation is recommended for cases with persistent dysphagia despite effective treatment of inflammation, with risks including perforation and bleeding. <br /><br />Monitoring for disease remission is advised through periodic endoscopy and symptom assessment. Successful management of the condition requires long-term follow-up to prevent complications and optimize patient outcomes. The overarching message is that clinical history and EGD with biopsies are crucial for diagnosing EOE, and informed consent is essential for procedures like esophageal dilation.

Asset Subtitle

Sumeet Tewani, MD, FASGE and Sarah Enslin, PA-C

Keywords

esophageal strictures

Advanced Practice Providers

Eosinophilic Esophagitis

food impaction

Proton Pump Inhibitor

endoscopy

topical corticosteroids

esophageal dilation

dupilumab

disease remission