Hello, my name is Kimberly Kearns. I'm an adult nurse practitioner with a specialty in gastroenterology. I work for Julie Health and Care in Hoffman Estates, Illinois. Hi, I'm Jennifer Lightdale. I am Associate Chief of the Division of Gastroenterology, Hepatology, and Nutrition at Boston Children's Hospital and a professor of pediatrics at Harvard Medical School. Eosinophilic esophagitis is a condition that generally occurs in people with a predisposition to atopy. So if you're likely to get atopic conditions like asthma, eczema, seasonal allergies, or food allergies, that puts you at higher risk. We do see it more often in men or males compared to females, and it is generally in non-Hispanic white populations. Of course, we recognize that the age of onset for EOE kind of represents a bimodal kind of diagnosis, with children being diagnosed at an earlier peak, usually around five to ten years of age. And then, of course, we see adults maybe around the age of 30, right? And several studies have highlighted that there's actually a prolonged pre-diagnosis of symptoms that sometimes could actually allow us to offer an earlier opportunity to make the diagnosis for our patients. The importance of this module for trainers is it's your chance to highlight this disease as a chronic lifelong condition that progresses over time. And if you understand what you're looking for, you're going to pick it up earlier and ideally treat the patient and optimize their outcomes. Children are much more likely to present with feeding difficulties. Their esophageal dysfunction is something they're having trouble articulating, but they often just won't eat well. Sometimes they are refluxing, and sometimes they are also vomiting, but it often can just be poor eating that is a giveaway. So, in contrast to what we were just hearing in regards to clinical presentation for children, adult clinical presentation is different. Dysphagia is usually the predominant symptom, noted in about 70 to 80 percent of patients, food impaction, heartburn reflux, chest pain, and even upper abdominal pain. Now, Dr. Lightdale and I would also like to talk to you about some of the differences that we see from an endoscopic perspective as well. Right. So, kids, because it's really more about not yet the fibrous stenosis, they will have inflammatory changes in the esophagus. So, you're going to see edema, pallor maybe, also exudate, and you can go on to get the rings, but that's going to happen later. Right, Kim. Great. Which, in comparison to adults, as Dr. Lightdale clearly defined earlier, we know this is a progressive disease. So, adults present with more fibrotic features, like ring and strictures. Once we've diagnosed eosinophilic esophagitis in children, it usually means they're going to go on over the course of their life to have multiple endoscopies, and one of the important things you can do is use a very standardized way of documenting using the ERIFS score to really get at whether they have edema, rings, exudate, or furrows, really getting that at every endoscopy. And what you'll see over time is the children will have edema in the beginning and maybe the furrows and maybe the exudate, and then over time, they're also going to have rings and strictures with the S at the end. So, the ERIFS is really a nice way to see longitudinally how the disease is changing over time. As an advanced practice provider, I find that it is so important with the field of gastroenterology changing, and even with the utilization of APPs in clinical practice, that we must understand the clinical nature of eosinophilic esophagitis. And part of this module and the key take-home points is really understanding the chronic nature of this disease. And I think what we really need to understand is recognizing symptoms, recognizing them early in our patients, and, of course, how to intervene to prevent the sequelae of the natural history of this disease. I think as the trainer using this module, there's a certain interest in making sure people feel an urgency to making the diagnosis. Patients are uncomfortable with EOE. They're often thin because they don't eat very well. That really starts in childhood and continues on through adulthood. They may be afraid of restaurants. They may find themselves having to drink water with every bite that they take. They are uncomfortable. And you're trying to pick that up as soon as you possibly can because that way you can help the patients to feel better. So, as the trainer, you're trying to get people to understand that this is a disease you want to recognize when it's happening and get the patients diagnosed so that they can get appropriate management. As an advanced practice provider, utilizing this module as a training tool, I would tell you some of the key take-home points is really expressing to your audience that eosinophilic esophagitis is a chronic, progressive, lifelong condition of the esophagus. It is imperative that we actually, as the trainer, help our other colleagues recognize symptoms present differently according to age, knowing that children and infants will present differently than our adult population. An early intervention is key in providing patient outcomes that we know are going to be optimal because we want to, of course, halt that disease progression. So, really, at this point, I want to wish you a lot of luck as you go out there and try to educate the world about EOE. Really get your colleagues excited to understand what it is and pick up the disease. And, of course, as you're going through the module and learning how to teach about EOE, if you have any questions or ways that you think we could improve things, please do let us know.

eosinophilic esophagitis

atopic conditions

early intervention

dysphagia

ERIFS documentation