Advanced Practice Provider EoE Program (Live/Virtual) | November 2024-Understanding the Patient’s Journey to Diagnosis

Pdf Summary

The document provides a comprehensive overview of Eosinophilic Esophagitis (EoE), detailing the patient’s journey to diagnosis and treatment options. EoE is described as a chronic, immune-mediated, food-antigen-driven disease characterized by esophageal dysfunction. The diagnosis requires a biopsy showing eosinophil-predominant inflammation with a threshold of at least 15 eosinophils per high-power field.<br /><br />The typical presentation for adults includes dysphagia, food impaction, heartburn, and chest pain, with a noted prevalence in males, particularly those with an atopic history. In children, symptoms may include feeding difficulties, vomiting, and gastroesophageal reflux. The document also discusses the global incidence of EoE, the diagnostic challenges leading to delayed diagnosis, and the different presentations by age.<br /><br />Four key treatment approaches are highlighted: Proton Pump Inhibitors (PPIs), topical corticosteroids, biologics, and dietary elimination. PPIs help by suppressing eotaxin-3 secretion and enhancing the esophageal barrier function. Topical corticosteroids, like budesonide, have shown efficacy in managing EoE symptoms with practical dosage tips offered for clinicians. Biologics, notably Dupilumab, are introduced for use in patients from one year old, based on their impact on histologic and symptomatic remission and overall safety profile. Dietary elimination is also a crucial therapeutic component, often involving the removal of specific allergens to alleviate symptoms.<br /><br />The importance of individualized treatment plans is emphasized, considering factors like efficacy, patient preference, disease severity, and insurance coverage. Patient involvement through shared decision-making is crucial for effective management. Ultimately, the goal of EoE therapy includes improving esophageal function and preventing complications associated with long-term esophageal inflammation and remodeling.

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Ilche T. Nonevski, MD, MBA

Keywords

Eosinophilic Esophagitis

EoE diagnosis

esophageal dysfunction

eosinophil inflammation

dysphagia

treatment options

Proton Pump Inhibitors

topical corticosteroids

biologics

dietary elimination