My name is Ada Sola, I am a second year GI fellow at Vanderbilt and I am doing gastroenterology fellowship. Over the years I have had a lot of patients coming in with dysphagia and then endoscopically finding, diagnosing them with EOE, even looking at the pathology and I have just become more interested in the esophagus and this opportunity came about and that is how my interest in EOE kind of blossomed. I think, you know, coming out of internal medicine training, EOE was something that we learned about but we did not really know and so now we are having patients coming in and we are diagnosing them with EOE. Our conversations are usually, what are the treatment options, why are we doing whatever options we ultimately decide, who is more appropriate to do like a food elimination diet versus trialing them on PPIs or, you know, steroids or even to PXENT, I think those are kind of the conversations that we are currently having about EOE. This module's goal is really to highlight that EOE is a chronic dysfunction of the immune system, immune system dysregulation. The genes that are responsible or play a role in EOE are still being understood but what we know is that, you know, in addition to food allergens and arrow allergens, in combination with this genetic predisposition, there are people that have, you know, altered function of their, the epithelial layer of their esophagus and that allows for these allergens to get to the deeper layers of the esophagus and then lead to this immune cascade which could involve upregulation of certain molecules and cytokines and then ultimately increasing the amount of eosinophils that we see in the esophagus. What we know is that eosinophilic esophagitis is, you know, like I've said, an immune disorder involving eosinophils of the esophagus but you can also have eosinophilic disorders of other parts of the GI system, a condition that we globally refer to as EGID, it stands for eosinophilic gastrointestinal disorders. The key differentiators really involves the organ that these eosinophils tend to impact the most. So, for example, if someone has eosinophilic, you know, gastritis, for example, they could present more with abdominal pain, nausea, vomiting, as opposed to, you know, the dysphagia that we tend to see with the fibrostenotic version of the EOE. If someone has eosinophilic colitis, for example, they can present with some bleeding out of the bottom, something we refer to as hematochezia, they could have increasing urgency to go to the bathroom, something we refer to as tenesmus. And so, globally, eosinophils can also affect other GI organs and cause symptoms, and the symptoms really depend on what organ is predominantly involved in the disease. When we think about eosinophilic esophagitis, we have pharmacologic options that are FDA approved. We don't necessarily have those options for the other EGIDs, and so that's basically what we know for right now. What we currently understand about eosinophilic esophagitis is that it's an inflammatory condition that could progress to a fibrostenotic disease condition, and, you know, normally when this disease process starts out, usually in children, they could present as, you know, not wanting to eat, kind of food aversion, and over time, as this inflammation progresses, you start having more inflammation, such that in the adult population, people tend to present more with, you know, the sensation that things are getting stuck in the esophagus, something we call dysphagia, and that, you know, impacts even how we treat them, not just with medicines, but they could also require some dilation of the esophagus. I think it's really important to understand the pathophysiology of eosinophilic esophagitis in that this is, like I mentioned earlier, a chronic inflammatory disease state that could happen. Particularly, there are very important cytokines and molecules that are at play. Most importantly is Th2. There's IL-5, IL-4, IL-13, all of these molecules and cytokines play important roles in increasing the amount of eosinophils, mast cells, that then wreak havoc. These cytokines are also very important targets for pharmacologic therapies that we have available currently, and so just understanding the overall pathophysiology can help you understand why exactly we're using certain medicines in trying to treat eosinophilic esophagitis, or why people recommend the six-food elimination diet as well in trying to treat this disease. So my recommendation is for you to really understand the pathophysiology of eosinophilic esophagitis. As a fellow, I have found this to be very important, and it's going to change how I even talk to my patients about eosinophilic esophagitis, and it's particularly important for all of us to understand why it is that we are treating it the way that we are, and also understanding the recommendations that we need to patients.

eosinophilic esophagitis

gastroenterology

Dr. Ada Sola

treatment strategies

immune system dysfunction