Advanced Practice Provider EoE Program (Live/Virtual) | November 2024-The Eosinophilic Attack

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The presentation by Dr. Safia N. Salaria at the Cleveland Clinic focuses on eosinophilic esophagitis (EoE), a chronic immune-mediated esophageal disease. Clinically, EoE presents with symptoms associated with esophageal dysfunction, while histologically, it is marked by eosinophil-predominant inflammation. EoE has a higher prevalence in males, predominantly affecting the 30-44 age group, and is more common in North America and Europe relative to Asia. There are notable associations with atopic diseases such as food allergies, asthma, eczema, and allergic rhinitis.<br /><br />Key genetic factors involved in EoE include mutations in genes like CAPN14, TSLP, and STAT6. Environmental factors during early life, such as antibiotic exposure, cesarean births, and premature births, also contribute to the disease. The disease is diagnosed histologically with evidence of at least 15 eosinophils per high power field, often accompanied by distinct endoscopic findings such as narrowing of the esophagus, rings, furrows, and edema.<br /><br />Pathologists use Hematoxylin and Eosin staining to examine esophageal biopsies. Histologic analysis reveals eosinophilic infiltration predominantly in the esophagus. Challenges in diagnosing EoE include insufficient correlation with symptoms, sampling variability, and distinguishing it from conditions like reflux esophagitis. Comparing EoE with reflux esophagitis, EoE more frequently presents with solid food impaction and no typical heartburn. The endoscopic and histological presentations differ markedly, aiding differentiation.<br /><br />Treatment of EoE influences biopsy results, with possible outcomes ranging from complete remission to progression. Diagnosis should integrate clinical history, endoscopic findings, previous pathology, and repeat biopsies to improve diagnostic accuracy. Overall, the study underscores the complexity of diagnosing EoE and the importance of a comprehensive approach that combines histological, clinical, and genetic insights.

Asset Subtitle

Safia Salaria, MD, MMHC

Keywords

eosinophilic esophagitis

esophageal dysfunction

eosinophil inflammation

atopic diseases

genetic factors

environmental factors

histologic diagnosis

Hematoxylin and Eosin staining

reflux esophagitis

treatment outcomes