EGD Masterclass: EoE, Strictures, and Pre-malignant Gastric Conditions (Virtual Only) | January 2023-Session 2 Case Study Question and Answer

Video Transcription

Video Summary

In this video, a case of a 30-year-old patient with occasional solid food dysphagia is presented. The initial endoscopy showed features consistent with eosinophilic esophagitis (EOE), including edema, rings, furrows, and exudate. Biopsies confirmed the diagnosis of EOE. The patient was started on proton pump inhibitor (PPI) therapy, which resolved the dysphagia but did not completely eliminate the endoscopic findings. A repeat endoscopy showed some improvement but persistent furrowing and edema. Biopsies revealed increased eosinophils in the distal esophagus. The patient was then started on viscous budesonide. A repeat endoscopy showed similar findings, indicating persistent activity. The discussion explores potential treatment options, including combo therapy, different formulations of steroids, diet therapy, and depilumab. The need for surveillance endoscopy in EOE is emphasized, as symptoms may not always reflect the endoscopic and histologic activity. The thresholds for eosinophil counts and the duration of therapy are discussed. Finally, the use of calcium channel blockers and the use of dilation in patients with EOE are considered.

Keywords

30-year-old patient

solid food dysphagia

eosinophilic esophagitis

endoscopy

proton pump inhibitor therapy

biopsies