Welcome, everybody, to the module. I'm Crystal Lynch, an adult gastroenterologist and the director of the Esophageal Center at the University of Pennsylvania in Philadelphia. I am Seema Sebas. I'm a pediatric allergy immunology physician at the University of California, San Diego, and Rady Children's Hospital in San Diego. Welcome to the module. Hello, everybody. My name is Ilche Noneski. I'm an adult gastroenterologist at Rockford Gastroenterology Associates and clinical assistant professor of medicine at the University of Illinois College of Medicine in Rockford. It's good to have you. So I think that one of the most important parts of this module is the emphasis on the increasing incidence and prevalence of EOE, as well as the relationship with other allergic diseases. And I think Dr. Sebas, given her expertise, may have more comments on the specifics of how important this is to our patients who are highly allergic and atopic. Thanks, Dr. Lynch. Yeah, I would agree with you completely. I think the important part of this module, and really one important takeaway, is to understand that EOE, like all other allergic diseases, is on the rise. And that's particularly salient when we talk about IgE-mediated food allergy, because that seems to be a real risk factor for the development of EOE, at least in children. So one thing that learners can take away will be that practical information about the relationship between atopy and EOE in the same person, as well as this increasing incidence and prevalence. Some real world experience, I can tell you, being an adult gastroenterologist on call in a relatively large community, we get food bolus impactions all the time. And it's not surprising that more and more of the people that we're seeing in the emergency departments are presenting with food boluses and endoscopic manifestations of eosinophilic esophagitis. You know, the rate of EOE presentations in the ER has increased tenfold since we've been taking note of it. And so this is a rising epidemiology, a rising clinical prevalence of incidence, and there's actually an impact downstream in the way we take care of patients in an urgent and regular medical setting. So this module is really chock full of information. And I think there are several key points to emphasize. The first one really being how the risk factors for EOE can help you in your clinical practice to identify these patients, to know when to put a patient under workup for EOE, or if you're not a gastroenterologist, when to refer a patient with a high suspicion for EOE, given their other history, given their risk factors. So I think those are important educational points to emphasize when using this module. Yes, I think this module has a lot of practical clinical information in the context of the rising epidemiology of EOE. One thing to consider that sort of got a practical clinical take home is the concurrent ATOV and allergic diseases that your patient may have when they have EOE, and really how to take care of those things and how sometimes treatments for something like food allergy can actually induce EOE if you're having, for example, oral immunotherapy. You may want to ask if that's something that your patient's actually going through, if they're going through some sort of a treatment that could be triggering their EOE. And then also potentially the consideration of the seasonality that may be existing in your patient if they have allergic rhinitis. It may change either the timing of when you do the endoscopy or perhaps when you realize that a patient has a lot of concurrent ATOV. It may change that your decision to do an endoscopy may be a little bit sooner. So I think there's a lot of practical information in this module. Yeah, to build on that, the first sets of slides really provide very concrete examples and understanding of what's happening from an incidence and prevalence standpoint. We're really probably approaching the tip of the iceberg in terms of where we're seeing EOE and its march along the kind of the atopic march that people talk about in allergy and immunology. But the end of the module basically takes all of the epidemiology and all the incidence and prevalence and turns it into a case study that gives you really a good example of what a typical patient or young adult patient that comes to the emergency department with symptoms or clinic with symptoms of EOE, what to be on the lookout endoscopically, what to see histologically. So it provides a nice connection between some of the epidemiology and what's happening. Another part of this module that is also practical is bringing up the point of how EOE is really a multidisciplinary disease, by which I think we really mean that if you have a patient in front of you who has the demographics of EOE and has dysphagia and you're worried about that, really make it a point to get a history about their other allergic diseases and then really consider referring them to an allergist because that will help you decide perhaps what season to do an endoscopy or are there other allergic diseases under good control? These are the things that can potentially influence the course of EOE. So to think about this as a multidisciplinary disease can be very helpful. I completely agree and I really appreciate the allergist taking that careful history because oftentimes patients have had chronic dysphagia issues since they were young and do not recognize that there's anything out of the ordinary. They go to the allergist for other allergic diseases and then they mention it and the allergist really is the one who recognizes that there's a high probability for EOE and sends that key referral. Seasonal allergies, I think patients intrinsically understand, is typically a chronic condition that waxes and wanes and having those patients understand that EOE is a chronic condition that may wax and wane. I think the multidisciplinary approach, I think, solidifies that and gives the patient understanding this isn't just a condition where you can dilate somebody and they're fine until the next food bowl comes in or they have dysphagia symptoms. This is a longstanding chronic inflammatory condition that requires long term therapy and having that multidisciplinary approach provides patients, I think, a greater understanding of what they're up against and how they're going to get better. If I could just add one more thing, I think one of the things that also impacts how the gastroenterologist interprets the biopsies that they take is really getting a good dietary history, because if your patient has food allergies and they're avoiding potential EOE triggers, it's possible that they may have a partially treated condition or, you know, they may be having, again, undergoing some sort of a therapy, either immunotherapy or even sublingual therapy for aeroallergens that can induce EOE, and that would be something that would be important to know as you're deciding how to care for your patient that has EOE. So we've talked about a lot of the key points of the module thus far, but I would also like to highlight that symptoms in adults can be very different from symptoms in children, and that's one key takeaway that I really want to stay with you, especially in providers who are seeing patients in that transition period. Thank you so much for joining us for this module. We hope that you learned a lot and best of luck. Totally agree with what Dr. Lynch just said. I think one of the key takeaway points is really please get a really good allergy history in your patients. Just take a couple of minutes to ask about their asthma. Ask if they're on an inhaler that contains a corticosteroid because they may be swallowing some of that. Ask about the foods that they're eating. Ask about if they have IgE-mediated food allergy and if they have allergic rhinitis or symptoms thereof so that you can really help take care of the whole atopic person. I'd really like to emphasize the importance of taking care of the whole atopic person rather than just that person's esophagus. So have a really good time with the module. I hope it's valuable to your practice. So the module is showing us that EOE is common, it's prevalent and should really be high on the differential diagnosis of patients that are coming in with esophageal symptoms, particularly dysphagia in adults. And so there are a lot of different things we have to think about in patients that are coming in with trouble swallowing. We always think about GERD-related complications, but if you take a good history, you'll find that EOE moves up on the list. And so that should be higher on your differential as you're seeing patients who are coming in with those types of symptoms. We hope you enjoyed this and all the other modules in the Trainer Trainer program.

eosinophilic esophagitis

allergic conditions

risk factors

multidisciplinary approach

allergy history