EoE Module 1 References-Nonevski et al iGIE J 2023 Eosinophilic esophagitis for the advanced practice provider

Nonevski et al iGIE J 2023 Eosinophilic esophagitis for the advanced practice provider

Pdf Summary

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition increasingly recognized for causing various upper gastrointestinal (GI) symptoms, such as dysphagia, food impaction, chest pain, and heartburn in adults, while children often experience nonspecific symptoms like vomiting and failure to thrive. It involves a complex interaction between environmental allergens and the immune system, leading to the recruitment of eosinophils to the esophagus, causing long-term inflammation and fibrosis.<br /><br />EoE's incidence and prevalence have been rising, with an estimated prevalence of 34 per 100,000 and an annual incidence of about 4 per 100,000. The condition predominantly affects males, white individuals, and those with allergic conditions like asthma and eczema.<br /><br />Diagnosis of EoE is primarily via endoscopy with esophageal biopsies, revealing common features like linear furrows, concentric rings, and strictures. A histological finding of at least 15 eosinophils per high-power field confirms the diagnosis after excluding other diseases.<br /><br />Treatment of EoE, which has no definitive cure, aims for histologic remission and symptom reduction. Options include:<br />1. Elimination diet: Avoiding common allergens such as milk, wheat, egg, soy, nuts, and seafood has shown significant efficacy in achieving remission.<br />2. Proton pump inhibitors (PPIs): Initially used only for diagnosis, PPIs now serve as a treatment option, offering histologic and symptomatic improvement in many patients.<br />3. Topical corticosteroids: Swallowed formulations like fluticasone and budesonide offer substantial histologic remission but require long-term management due to recurrence on discontinuation.<br />4. Endoscopic dilation: This addresses fibrosis and stricture formation resulting from prolonged inflammation, providing symptomatic relief but not resolving the underlying inflammation.<br /><br />For refractory cases, biologics like Dupilumab have recently been approved, demonstrating effectiveness in achieving histologic remission.<br /><br />The condition requires a comprehensive approach by advanced practice providers to consider patient history, especially related to atopic diseases, and manage treatment options effectively to prevent long-term complications.

Keywords

Eosinophilic esophagitis

chronic inflammatory condition

upper gastrointestinal symptoms

dysphagia

food impaction

environmental allergens

esophageal biopsies

elimination diet

topical corticosteroids

biologics