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

EoE Understanding the Patient’s Journey to Diagnosis

Pdf Summary

This presentation by Dr. Ilche T. Nonevski offers a comprehensive overview of Eosinophilic Esophagitis (EoE), focusing on the patient journey toward diagnosis and treatment options.<br /><br />EoE is defined as a chronic, immune-mediated, food antigen-driven condition characterized by esophageal dysfunction and eosinophilic-predominant inflammation with at least 15 eosinophils per high-power field on biopsy. It commonly affects males in their 30s and 40s, often associated with atopic conditions such as asthma, allergic rhinitis, and food sensitivities. The disease is often misdiagnosed for an average of 7 years, leading to complications like fibrosis and strictures due to diagnostic delays.<br /><br />Clinically, EoE in children presents with feeding difficulties, vomiting, and reflux-like symptoms, progressing to dysphagia and food impaction in adults. Endoscopic findings include edema, rings, exudates, furrows, and strictures (EREFS features).<br /><br />Treatment goals aim for deep remission—symptom control, inflammation suppression, and prevention of remodeling complications. Therapeutic options include:<br /><br />1. Proton Pump Inhibitors (PPIs): Offer symptom relief and reduce eosinophils via mechanisms beyond acid suppression; started usually twice daily with follow-up endoscopy at 12 weeks.<br /><br />2. Topical Steroids: Budesonide oral suspension and fluticasone inhalers are effective, with clinical trials showing significant histologic remission; generally safe but require dosing education.<br /><br />3. Biologics: Dupilumab, an IL-4/IL-13 monoclonal antibody, is approved for patients aged 1 year and older and shows strong histologic and symptom improvement. It is favored in cases with multiple atopic comorbidities or when other treatments fail. Side effects include injection site reactions and nasopharyngitis.<br /><br />Additional treatments include dietary elimination strategies and esophageal dilation for strictures.<br /><br />The choice of therapy is individualized, considering efficacy, adverse effects, patient preferences, disease severity, insurance coverage, and available resources, with shared decision-making emphasized.<br /><br />EoE's prevalence is increasing globally, with its natural history progressing from inflammation to fibrosis, highlighting the importance of early diagnosis and tailored management to prevent complications.

Keywords

Eosinophilic Esophagitis

EoE

esophageal dysfunction

eosinophilic inflammation

diagnosis delay

proton pump inhibitors

topical steroids

dupilumab

atopic conditions

esophageal dilation