Hi, I'm Dr. Nirmala Gonsalves, Professor of Medicine in the Division of Gastroenterology and Hepatology at Northwestern University Feinberg School of Medicine. At Northwestern, I'm an adult gastroenterologist in the esophageal group, and within the esophageal group, I co-manage the eosinophilic GI disorders program. Hi, I'm Bethany Dorfler. I'm a clinical research dietitian in the Department of Gastroenterology and Hepatology at Feinberg School of Medicine at Northwestern. I work with eosinophilic patients and patients who have allergic bowel disorders, as well as dysmotility patients. So welcome to Module 8, Selecting Elimination Dietary Therapy in Eosinophilic Esophagitis. I'm very excited about this module because it really provides a broad overview and background for the use of dietary therapy in eosinophilic esophagitis. It walks the learner through the history behind dietary therapy, the different types of dietary therapy, a little input on shared decision-making, and considering different types of elimination dietary therapy, whether it's the six-food, four-food, two-food, one-food. We talk about step-up and step-down therapy. We then talk about specific patient factors that are important in that discussion with the patient, and then leave you with some tips and tricks for long-term success. This module will walk you through how to initiate the conversation with your patients about considering dietary therapy as one of their treatment options. We also set the stage for you to have resources to utilize with your patients in their care plan. To further hone down on some specifics in the module, we really hope that the information we're going to provide will give you the opportunity and resources to start this discussion with your patient. Important things to focus on within the module are, one, to really understand the different types of effectiveness of each diet therapy approach. And that way, you can have a better discussion with your patients. There are several tables and slides that really highlight those different approaches and the different effectiveness. The next thing is to really consider the downsides of dietary therapy and when you may steer patients away from this particular approach. One other important key takeaway is that when you're discussing all these approaches with your patient, is for the patient to really understand what this process looks like long-term. Important data is that 70% of these patients will have just one food trigger. And that's an important part of that discussion to have with the patient as they're thinking about starting this process. One important discussion element with your patients when considering dietary therapy is the lifestyle factors that set them up for success. You will see that the more food groups restricted, the better the success rates in dietary therapy. But that may not always be the right place to start for your patients. So considering lifestyle factors, travel, ability to prepare food for themselves, as well as the number of endoscopies needed to identify the trigger foods, these are all important points that we coach you through to set your patient up for success. So what I would suggest when you're going through this module is really starting from the beginning and walking yourself through it. We created this module in a way for you to have this context to have that discussion with your patients. Many times when you're talking to patients, they're asking you, well, why do I do diet therapy? What is the background? And this module really provides that opportunity. It gives you some history. It then walks you through the different types of dietary therapy and the effectiveness. It then walks you through different approaches from the step up to the step down therapy, and then gives you some tips and tricks for success. So it's a natural conversation to have with your patients if you go through those slides in that manner. This module also pairs well with Module 9, which takes a deeper dive into the nutritional strategies and tips for patients who decide to embark on diet therapy. So think of this module as setting the stage for the discussion point on your plan of care, and then Module 9 being your roadmap for how to implement the diet. So summary and key takeaway points for Module 8 are that food allergens are clearly linked with the development of EOE. Empirical elimination diet is favored over elemental and allergy-tested directing diet. Step up, step down, one, two, four, six food elimination diets are all effective treatments, and having that discussion with your patients is important. Also important is to go through the food reintroduction process and not leave patients on restrictive diet long-term. Seventy percent of patients have just one food trigger, and it is also important for long-term maintenance of diet therapy. Understanding what your patients eat may influence your plan of care. If they have restrictions already because of existing food allergies, it may factor into which diet therapy you decide upon. Working with a dietitian can help complete this plan of care. We hope that you've enjoyed Module 8 and have now the tools and the resources to use in your clinical practice to have the conversation about dietary therapy with EOE patients. If at your center you don't have those resources, at the end of the module there are numerous resources and tools that you can use to provide to your patients. We want to encourage you to incorporate dietary therapy as a treatment plan with your patients. If you don't have access to a dietitian within your group, these modules, both 8 and 9, are really designed to help build proficiency among staff members who can incorporate this type of diet therapy for your patients.

eosinophilic esophagitis

GI disorders

pathophysiology

treatment options

patient management

elimination dietary therapy

food trigger

dietitians

nutritional strategies