Hi, I'm Gary Falk. I'm a professor of medicine at the University of Pennsylvania Perelman School of Medicine. Hi, I'm Sachin Srinivasan, a third year gastroenterology fellow at the University of Kansas. So the reason it's important to understand other disease states that may mimic EOE symptoms and presentation is that the treatment of other diseases is very different than the treatment of EOE. So you'd like to have specific therapy for a specific disease and diagnosis that will give you very different outcomes in what's going to happen moving forward. In pediatric population, ranging from infancy to young adults, toddlers, the presentation of EOE has been sort of varied. It can be feeding issues where they have nausea, vomiting, and they're very nonspecific. But I think the most important thing is to be even mindful and consider this as a differential. There be some key features where there be allergic states, there might be other atopic conditions that might clue us in that we might be looking at a condition that is related, that might be related to EOE. And I think it's important for clinicians to be even cognizant of the existence of such conditions in related atopic conditions to make a diagnosis of EOE. Yeah, I think that pretty much covers it. The key thing for children is that this is a very nonspecific presentation, which is very different from adults where the presentation is fairly classic. For adults, EOE presentation is usually fairly typical, dysphagia to solids, chest discomfort. But there can be other nonspecific features such as classic reflux symptoms, more predominant chest pain. But usually the typical presentation of adults out of central casting is a young male with atopic features such as allergy, food allergies, asthma, eczema, who is having trouble swallowing. And that's very different than children where it's not quite as straightforward. I think that's sort of becoming, we're identifying more and more information on this. And I think the biggest thing that's sort of been unearthed, so to speak, is just like, you know, there are a lot of aero allergens. There's a wider spectrum of allergies. Allergy testing has become more available. And so it's sort of important to see how to clue that in into somebody who's having a workup of potential EOE. And I think this module sort of covers the tenets of when do we test for EOE? When do we have to test for allergens specifically? And I think it's important to understand the basic concepts of that. One of the key problems in the diagnosis of eosinophilic esophagitis is differentiating it from gastroesophageal reflux disease. And one of the problems with that is that you can have EOE alone, you can have GERD alone, or you can have overlap. And it's very nuanced sometimes how to sort that out. To help us with reflux right now, there are clear consensus criteria known as Lyon 2.0 conference that was just published in the last year. And the Lyon conference gives us the definition of GERD that we should be using right now, which is esophageal symptoms of heartburn, acid regurgitation, or esophageal chest pain in conjunction with objective evidence of reflux. And that objective evidence is either with macroscopic esophagitis, namely LA classification BCRD, or abnormal pH testing done while off of therapy. So there are some clinical and endoscopic predictors of EOE. Age, gender, presence of atopic conditions. These are some of the clinical features that would start pointing towards EOE in the presentation, of course, whether they're coming in with chest pain, difficulty swallowing. And then if they undergo an endoscopy, there are certain endoscopic features like edema, rings, exudates, linear furrowing, strictures, none of which are needed to make a diagnosis, but when present, kind of point us or make us think that we might be dealing with a case of EOE. So I think some of the key takeaways from this module would include the varied presentation of EOE in children versus adults, how to differentiate EOE specifically from other mimicking states, and particularly with gastroesophageal reflux disease, and how to use consensus definitions to clearly differentiate what EOE is, what GERD is, and is there an overlap kind of a situation. The other point we'd like to make is the importance of management of atopic conditions that are so prevalent in eosinophilic esophagitis. Gastroenterologists are not well trained in the management of these conditions, so we need the assistance of our colleagues in allergy and immunology. But where that's important is to help in the management of things like eczema, seasonal allergies, allergic rhinitis, asthma, and anaphylaxis to certain foods. Furthermore, it's well known that there can be flares of eosinophilic esophagitis in individuals who are well controlled on medications during allergy season. And again, teasing that out and working as a team to help our patients is critical for management of eosinophilic esophagitis. We would like to thank our viewers and hope that this educational module is of benefit. And should there be any questions or any comments, please feel free to reach out to us.

eosinophilic esophagitis

differentiation

pediatric vs adult

allergen testing

atopic conditions