Advanced Practice Provider EoE Program (Live/Virtual) | October 2025-Understanding the Patients Journey to Diagnosis

Video Transcription

Video Summary

Dr. Ilse Nornefsky discusses eosinophilic esophagitis (EOE), a chronic, immune-mediated inflammatory condition increasing globally. EOE primarily affects the esophagus, diagnosed through endoscopy and biopsy showing >15 eosinophils per high power field. It often presents with dysphagia, food impaction, and is strongly associated with atopic conditions such as asthma and allergies. The disease has a bimodal age distribution, often diagnosed in adults around their 30s but may begin earlier with delayed diagnosis common.<br /><br />Endoscopic signs include rings, linear furrows, exudates, and strictures. Untreated, inflammation leads to esophageal remodeling and fibrosis with increasing risk of strictures over time. Diagnosis requires differentiation from other causes like GERD, motility disorders, infections, and malignancies.<br /><br />Treatment goals focus on symptom relief, inflammation control, and prevention of fibrotic complications. Therapeutic options include proton pump inhibitors (PPIs), topical steroids (like budesonide and fluticasone), dietary elimination, and FDA-approved biologic dupilumab targeting IL-4/IL-13 pathways. PPIs help reduce acid exposure which may facilitate antigen penetration; steroids reduce eosinophilic inflammation. Dupilumab benefits patients with severe or refractory disease and concurrent atopic disorders.<br /><br />Management requires shared decision-making tailored to patient preferences, disease severity, and access to dietary or medical resources. Maintenance therapy is essential due to EOE’s chronic nature. Endoscopic dilation may relieve strictures but does not treat underlying inflammation. Ongoing monitoring with endoscopy and biopsy guides treatment efficacy.

Asset Subtitle

lche T. Nonevski, MD, MBA

Keywords

Eosinophilic Esophagitis

Chronic Inflammatory Disease

Esophageal Rings

Dysphagia

Topical Steroids

Dupilumab

Endoscopic Dilation