Advanced Practice Provider EoE Program (Live/Virtual) | October 2025-Highway to the Danger Zone

Highway to the Danger Zone

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This presentation discusses the crucial role of Advanced Practice Providers (APPs) in diagnosing and managing esophageal strictures, particularly those caused by eosinophilic esophagitis (EoE). A case study of a 36-year-old male with recurrent food impaction highlights typical symptoms such as food sticking and dysphagia, often prompting urgent evaluation. Diagnosis requires EGD with biopsy; clinical history alone is insufficient. The EREFS scoring system assesses endoscopic features including rings, exudates, furrows, and strictures, aiding in diagnosis and treatment planning.<br /><br />EoE is a chronic inflammatory condition leading to fibrosis and strictures if untreated. Goals of therapy include symptom elimination, mucosal inflammation reduction, stricture management, and complication prevention. Treatment options include elimination diets, proton pump inhibitors (PPIs), topical corticosteroids (such as swallowed fluticasone or compounded budesonide), and biologics like dupilumab. APPs collaborate closely with gastroenterologists in formulating and adjusting therapy based on symptom and histologic response.<br /><br />Stricture management often requires endoscopic dilation, either balloon or bougie, which is highly effective (95% symptom improvement) but carries risks including perforation (~0.3-0.38%), bleeding, and chest pain. Dilation is reserved for persistent symptoms despite optimized medical therapy and should be done gradually with a target lumen of 15-16mm. Post-procedure pain is common, and maintaining remission of underlying inflammation is essential to prevent recurrence.<br /><br />Follow-up involves repeat EGDs with biopsies to monitor remission, as symptom improvement alone is insufficient. Long-term management emphasizes recognition of symptoms, maintaining histologic remission, and collaboration between APPs and gastroenterologists for optimal outcomes in EoE patients with esophageal strictures. Early diagnosis and a multimodal approach improve prognosis and reduce complications.

Keywords

Advanced Practice Providers

Esophageal Strictures

Eosinophilic Esophagitis

Food Impaction

Dysphagia

EREFS Scoring System

Endoscopic Dilation

Proton Pump Inhibitors

Topical Corticosteroids

Dupilumab