Podcasts about Eosinophilic esophagitis

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. John Accarino, an allergist and immunologist at Massachusetts General Hospital and Mass General for Children, on the topic of immunology support for eosinophilic esophagitis (EoE). Dr. Accarino shares his experiences as a person living with food allergies, allergic asthma, peanut allergy, and eosinophilic esophagitis. He tells how his experiences help him in his work with patients. Dr. Accarino shares some education on a variety of allergy mechanisms and the treatments that mitigate them. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron. Ryan introduces co-host Holly Knotowicz.   [1:14] Holly introduces today's topic, immunology support for eosinophilic esophagitis (EoE), and introduces today's guest, Dr. John Accarino, an allergist and immunologist at Massachusetts General Hospital. Holly welcomes Dr. Accarino to Real Talk.   [1:49] Holly notes that Dr. Accarino is her allergist and immunologist.   [2:03] Dr. Accarino works at Massachusetts General Hospital and Mass General for Children. Allergy and Immunology is a field where he can see pediatrics and adults. Originally trained in pediatrics, now Dr. Accarino sees patients of all ages.   [2:23] Dr. Accarino grew up with allergies. He has experienced food allergies since he was young, along with allergic asthma, and some eczema, which he grew out of. Later in life, he was diagnosed with eosinophilic esophagitis. He talks with his patients about his experiences.   [2:47] Dr. Accarino also does research on drug allergies in the context of certain drug interactions that involve eosinophils.    [3:06] When Holly was referred to Dr. Accarino, it was for multiple sclerosis (MS). He told her, “It looks like you have EoE. I have EoE.” It was a huge relief to Holly not to have to explain EoE to her doctor.   [3:41] Some patients start to explain their EoE to Dr. Accarino, and he assures them he understands where they're coming from. Sometimes, he has to be careful not to think everyone has his symptoms, as there is a large spectrum of presentations.   [4:26] Dr. Accarino wasn't diagnosed with EoE until he was in his allergy fellowship, after he suspected it when he had a food impaction at a steakhouse at a graduation party from his pediatric residency. He tried to manage the EoE with lifestyle changes.   [5:39] Dr. Accarino didn't often go to see a doctor during residency, but he realized it was probably a good time to get an endoscopy.   [5:52] Holly shares how she was also diagnosed as a clinical fellow. She was subbing for someone on the GEDP team at Children's Hospital in Colorado. Listening to all the patients, she realized, “This sounds a little bit like me … What is going on?”   [6:23] Even with his medical background, it took Dr. Accarino some time to decide to get the endoscopy and biopsies. You or your doctor have to have a high level of suspicion to realize this isn't just reflux. Food doesn't get stuck in every person's throat.   [7:01] Thinking back, Dr. Accarino remembers an instance as a child when a dry muffin got stuck in his throat. He stayed calm and waited for it to pass. He thought it was normal.   [7:39] He drank a lot of water and chewed his food a lot. Those are markers of potential esophageal inflammation.   [8:20] Different groups have different management strategies for EoE. Dietary management, topical steroids, biologics. A subgroup of people with EoE are responsive to proton pump inhibitors (PPIs). Finding the best management strategy is a work in progress.   [8:53] With pediatric patients, the parents control the diet, and the children eat what is prepared. He notes that with adult patients, sometimes they let foods slip through.   [9:10] If you want to do a single-food elimination diet with dairy, there's a lot of dairy in the American diet. Dr. Accarino tried eliminating dairy and wheat, but he still had persistent eosinophils with dietary elimination.   [9:24] Dr. Accarino then tried PPIs. To know if you have PPI-responsive EoE, you might do twice-daily omeprazole at a significant dose. Have the endoscopy after a few weeks pass and see if the eosinophils are still present in the biopsy.   [9:59] Dr. Accarino did that recently and still has the eosinophils. He plans to talk to his gastroenterologist about considering dupilumab, but he feels that he can mitigate his subjective day-to-day experience of symptoms with dietary elimination and PPIs.    [10:24] If you still have the presence of eosinophils on biopsy, there's still inflammation happening. In the long term, you still have to worry about fibrosis and narrowing.    [10:34] The last treatment Dr. Accarino tried was as a research participant in a study for dissolvable fluticasone. He received either the medication or a placebo; he doesn't know which.   [11:01] To stay in the study, he had to journal and report his symptoms regularly. He didn't have enough symptoms to stay in the study. They were looking for a baseline to see how it changed with either the placebo or the medication.   [11:20] In research, you have to have a baseline to start, and then you want to see improvement, plus or minus. With EoE, it's difficult. You have the biopsy and eosinophils, but there's a large spectrum of symptoms that people may experience.   [12:40] Holly appreciates Dr. Accarino's unique perspective as a doctor with EoE who has experienced various treatments and diets. He understands the concerns of his patients.   [12:43] Dr. Accarino says even taking a twice-daily PPI or other medication is difficult for a lot of people, and that's the most simple of these therapies.   [13:06] Dr. Accarino wants to validate everyone's experience in terms of how difficult it is to treat this disorder, how it may present in different ways, and how there may be a delay in diagnosis.   [13:16] This isn't IgE-mediated immediate food allergy, where you eat a food and may have swelling within minutes; you may have flushing or hives. That's very clear. With EoE, it's a different mechanism; in many cases, there is a delay.   [14:37] Allergy, in general, is under the purview of clinical immunology. Dr. Accarino is allergic to peanuts and has an  IgE-mediated immediate reaction to them. If he eats a peanut, he has symptoms within minutes. He could have anaphylaxis. As a result, he carries an epinephrine auto-injector.   [15:01] If Dr. Accarino has a skin test, it will be positive for peanut. He has IgE antibodies to peanuts. He also has oral allergy syndrome where the body mistakes certain fruits, vegetables, or nuts with certain tree pollens or grass pollens.   [15:23] Oral allergy syndrome is usually a lower-risk condition where it's a less-stable protein that once cooked might not produce any symptoms. If it's raw when you consume it, you may have oral itching, a bit of throat discomfort, or tongue itching. [15:54] Your stomach acid breaks it down so it doesn't get into your bloodstream and you shouldn't have a systemic reaction.   [16:01] If Dr. Accarino eats a peanut, his stomach acid doesn't break down the high-risk, stable peanut protein, it gets into his bloodstream, and he can have a systemic anaphylactic reaction.   [16:20] Chronic EoE symptoms can present with something like a food impaction, or bad reflux or belly pain, and nausea. The reaction may not be immediate. It may be progressive over days or weeks.   [16:38] FIRE is an interesting condition that takes some time to narrow down. It's an immediate response of the esophagus, but we don't think it's histamine-mediated.   [16:56] We don't know, exactly, the mechanism but it's in people with eosinophilic esophagitis. They feel differently, and there would be different specific food triggers.   [17:11]  It took some time to figure out what was going on. Dr. Accarino felt like he had a lump in his throat, then a lump in his chest, nausea, and belly pain. It felt like a slow progression of EoE symptoms, and it was from specific food triggers, in his case.   [17:30] In some of the FIRE literature, they looked at banana and avocado. For Dr. Accarino, it took a couple of exposures to protein bars and milk protein whey isolate, specific to protein bars he had multiple times, until he figured out that was the trigger.   [17:50] Another protein whey isolate that Dr. Accarino scooped as a powder and made into a shake also led to FIRE.   [17:55] It took that event for Dr. Accarino to figure out it wasn't just a flareup of EoE or reflux but some trigger that caused this response that wasn't anaphylaxis but may be due to the recruitment of eosinophils or some immediate process not well understood.   [18:18] FIRE is going to be very hard to research. How would we figure this out? Would we bring someone in and do an endoscopy immediately and see what happens? There's a lot of descriptive data and case series.   [18:32] Dr. Accarino has had experiences when he knew it wasn't an immediate anaphylactic reaction, oral allergy, or reflux. He asked what else it could be in the context of EoE. When he looked at different case series, that's the presentation he had.   [19:17] Dr. Accarino acknowledges that having personal experience with FIRE, oral allergies, and IgE-mediated allergies, on top of EoE, has influenced his work as a medical professional. He can share anecdotes with patients as he explains the available testing.   [19:39] Dr. Accarino says a lot of immunology and allergy is explaining the diagnostic tools and management strategies we have and what we think is going on.   [19:50] The immune system is infinitely complex, and a lot of the practice is making a digestible analogy, not just in the context of allergic conditions but also everything with the immune system. There are so many cells doing so many different things.   [20:04] Dr. Accarino explains false positives in testing. He has positive scratch tests for peanuts, cashews, and almonds, which shows he has IgE for each of them. He is allergic to peanuts, but he can eat cashews and almonds. Those are false positives.    [20:56] When a scratch test is negative for immediate food allergy, it's a powerful predictive tool. But you may get false positives. How positive is it? There might be room for more discussion.   [21:10] There may be more hesitation for people who do large panels of food testing without any history of reacting to any foods.   [21:31] Some people have EoE triggered by milk or wheat but have negative skin tests. That doesn't mean they aren't triggered by these foods. The skin test is an IgE histamine mast cell mechanism, not for eosinophils, which are other immune cells.   [21:58] We go down these steps of thinking about diagnostic triggers and eventually treatment for those immediate symptoms mentioned for EoE.   [22:09] Dr. Accarino doesn't expect FIRE to be responsive to epinephrine. He doesn't have to stabilize the mast cells. It's a chronic disease that's flaring up. You treat it with a chronic type of treatment.   [24:10] Dr. Accarino says that for a doctor, immunology is rewarding, interesting, and complex, but it's intimidating until you get your foothold and see patients and clinical experiences.   [25:14] A lot of medical students and residents are a little fearful of immunology. They might not think about it too much. Dr. Accarino loves to talk about it and think about it. He can't think of anything more complex in terms of systems within our body.   [25:37] Ryan comments on his experiences with IgE-mediated food allergies, some environmental allergies that he has no idea how they work, and EoE, which he believes he has a good grasp on.   [25:55] Ryan imagines that having a physician with a good understanding of the immune system and also personal experience would be helpful for a patient with multiple allergic conditions.   [26:13] Dr. Accarino sees a large overlap of seasonal or year-round environmental allergies and EoE. There are some studies that show that endoscopies on patients with EoE may change at different times of the year if they have underlying seasonal allergies.   [26:33] Some people who have food allergies also have EoE or other eosinophilic disorders. Some discussions with them may be about blood tests that detect eosinophils in the bloodstream versus biopsies of the esophagus, stomach, or colon.   [27:15] It's thinking about what tests are available, what they tell us, and how to use them to predict the next steps, things like dietary changes or for immediate food allergy, considering challenges versus full avoidance. Each test has its pluses and minuses.   [27:35] People like a clear test, and they like an easy fix, but sometimes there's a lot of nuanced conversation of shared decision-making and trying things in a supervised setting.   [27:57] Holly speaks as a patient of the investigative testing Dr. Acarino is doing with her immune system trying to figure it out along with her MS and EoE.   [28:14] Dr. Accarino says the words immune system, immunity, and inflammation are used a lot in talking about foods. Dr. Accarino uses the framework of the immune system trying to help you.   [28:42] Sometimes, instead of making helpful antibodies to things like vaccines or viruses, that give you protection, the immune system makes antibodies that attack a certain organ or your joints.   [29:02] Dr. Accarino thinks of treatments that suppress the immune system in certain ways. Some treatments cool down the populations of many different immune cells. Oral steroids and prednisone are used for many conditions for autoimmune flares.    [29:29] Oral steroids, in the long term, may lead to weight gain, bone density changes, and diabetes. The big push for many diseases is toward non-steroidal biologics to target specific cells that cause disease.   [29:59] For Crohn's disease, a specific monoclonal antibody is used to target TNF-alpha molecules and blocks that inflammation pathway.   [30:14] For EoE, dupilumab, a specifically designed antibody, blocks a specific receptor in a specific pathway so the immune system doesn't have to be shut down and the patient doesn't have the side effects of steroids. It's a targeted therapy.   [30:32] What you see in commercials for injectable medications are large, designed antibodies that, if you took them in a pill form, your stomach acid would break down and digest. So they are injections and infusions that go directly into the bloodstream.   [31:22] Medications that end in -mab are monoclonal antibodies. They are very large molecules that would not be stable in stomach acid.   [32:09] Dr. Accarino talks of eosinophil normal function and aberrant function. IgE-mediated reactions are usually related to mast cells, a type of immune cell that shouldn't be in the bloodstream.   [32:54] Dr. Accarino can do a CBC with differential to see the number of white blood cells and the number of red blood cells. The differential of white blood cells will include neutrophils, lymphocytes, and eosinophils. It shouldn't show mast cells.   [33:19] If you have mast cells in your bloodstream, that's mastocytosis, a different problem. Mast cells live in your skin, in your gut, and around your blood vessels. They're full of granules like histamine and tryptase.   [33:38] Dr. Accarino explains how mast cells release their contents and how he would treat the resulting swelling or itch with an antihistamine or epinephrine. Epinephrine treats systemic reactions and stabilizes the mast cells.   [34:16] Mast cells have many receptors and may be triggered by many things other than IgE. This is a conversation Dr. Accarino has with patients who have chronic hives unrelated to any foods.   [34:29] Some people get hives from non-steroidal anti-inflammatory drugs NSAIDs. Some get hives from vancomycin. Some get hives when the temperature changes, from tight clothing, or from IV contrast. It's not an IgE-mediated mechanism, but it's still mast cells being degranulated.   [35:45] Dr. Accarino says people see hives and they think allergy. But, like EoE, it doesn't involve histamine. There can be hives that aren't related to allergies. This can be idiopathic urticaria or spontaneous urticaria.   [36:04] Sometimes, when switching from a day shift to a night shift, hormonal changes will trigger hives. Sometimes, the stress of having a family member in the hospital will cause hives. An accumulation of triggers can lead to mast cell degranulation.   [36:38] There are many ways that allergy can have different mechanisms and treatments, with different cells involved. There are different molecules that cause symptoms and manifestations.   [36:50] Navigating that and understanding what might be going on can give people a sense of reassurance. The biggest fear is a life-threatening allergic reaction. People will read about fatal anaphylaxis and wonder if it will happen to them with their condition.   [37:16] Sometimes, thinking of the cells involved and the pathways may give a level of reassurance that this may not be the same thing that they read about.   [37:28] Ryan thanks Dr. Accarino for joining us today.   [37:37] Dr. Accarino says it was nice to reflect on things and to go through different scenarios and experiences he has gone through. It was nice to have the opportunity to share them with Ryan, Holly, and all the listeners.   [37:57] For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [38:06] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [38:15] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [38:25] Ryan thanks Dr. Accarino for joining us today for this fun conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. John Accarino, MD, Allergist and Immunologist at Massachusetts General Hospital and Mass General for Children Episode 034: Food-Induced Response and Eosinophilic Esophagitis   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “Allergy and immunology is a field where I can see pediatrics and adults. I was originally trained in pediatrics, but now I see all ages, from infants up until older adults.” — Dr. John Accarino   “Part of the conversation sometimes is trying not to overly bias myself, where I say, ‘Oh, this is my experience.' … Like many diseases, there's a large spectrum of presentations, … different symptoms that people have.” — Dr. John Accarino   “We don't think [Food-Induced Response in Eosinophilic Esophagitis is] histamine-mediated. We don't know exactly the mechanism, but it's in people with eosinophilic esophagitis. They feel differently, and there would be different specific food triggers. It took some time to figure out that was going on.” — Dr. John Accarino   “When a scratch test is negative for immediate food allergy, it's a very powerful predictive tool. But there are times that you may get false positives. How positive is it? There might be room for more discussion.” — Dr. John Accarino   “There are a lot of ways that allergy can have different mechanisms and different treatments, with different cells involved.” — Dr. John Accarino

In this episode, hosts Drs. Temara Hajjat and Jenn Lee talk to Drs. Glenn Furuta and Noam Zevit about the diagnosis and management of eosinophilic GI disorders (EGIDs) beyond eosinophilic esophagitis based on the new joint ESPGHAN/NASPGHAN recommendations.Learning Objectives:Discuss the diagnosis of non-EoE EGIDs.Explain the role of pathology in diagnosis of non-EoE EGIDs.Review management of non-EoE EGIDs.References:Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic GI Disorders Beyond Eosinophilic EsophagitisSupport the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Dr. Lisa Mathew interviews Dr. Vijay Yajnik, vice president and head of U.S. Medical, Gastroenterology, at Takeda about how the prevalence of eosinophilic esophagitis (EoE) is increasing, and evidence is growing that EoE is not a rare disease, but an underdiagnosed one. Approximately one in 2000 people in the U.S. live with EoE, and the incidence and prevalence of eosinophilic esophagitis have steadily increased over time. Join Dr. Mathew and Dr. Yajnik as they explore progress that has been made in diagnosing and treating EoE, and some recent studies that could influence patient care. Produced by Andrew Sousa and Hayden Margolis for Steadfast Collaborative, LLC Mixed and mastered by Hayden Margolis Gastro Broadcast, Episode 73, presented by TissueCypher from Castle Biosciences

In this episode, we're diving into the latest ACG Clinical Guideline for the Diagnosis and Management of Eosinophilic Esophagitis (EoE)—a major update that reflects the most current understanding of this chronic, immune-mediated disease. Joining us to break it all down are two of the experts who co-authored these guidelines: Dr. Amanda B. Muir, Pediatric Gastroenterologist at The Children's Hospital of Philadelphia Dr. Nirmala Gonsalves, Gastroenterologist at Northwestern University Feinberg School of Medicine What We Cover: What is EoE? Understanding symptoms and diagnosis Key updates in the latest guidelines and what they mean for patients Treatment options for both children and adults Whether you're living with EoE, caring for someone with it, or simply want a deeper understanding of this condition, this episode is for you! This episode is brought to you by Sanofi, and presented in collaboration with the American College of Gastroenterology's Patient Care Committee.

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Wayne Shreffler, Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital. Dr. Shreffler is also an investigator at The Center for Immunology and Inflammatory Disease and The Food Allergy Science Initiative. His research is focused on understanding how adaptive immunity to dietary antigens is both naturally regulated and modulated by therapy in the context of food allergy. This interview covers the results of a research paper on The Intersection of Food Allergy and Eosinophilic Esophagitis, co-authored by Dr. Shreffler. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron. Ryan introduces co-host, Holly Knotowicz.   [1:15] Holly introduces today's topic, the intersection of food allergy and eosinophilic esophagitis.   [1:26] Holly introduces today's guest, Dr. Wayne Shreffler, Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital and an investigator at The Center for Immunology and Inflammatory Disease and The Food Allergy Science Initiative.   [1:43] Dr. Shreffler's research is focused on understanding how adaptive immunity to dietary antigens is both naturally regulated and modulated by therapy in the context of food allergy.   [1:54] Holly welcomes Dr. Shreffler to Real Talk. When Holly moved to Maine, she sent her patients to Dr. Shreffler at Mass General.   [2:25] Dr. Shreffler trained in New York on a Ph.D. track. He was interested in parasitic diseases and the Th2 immune response. Jane Curtis, a program director at Albert Einstein College of Medicine, encouraged him to consider MD/PhD programs. He did.   [3:31] Jane Curtis connected him to Hugh Sampson, who was working with others to help understand the clinical prevalence of food allergy and allergens.   [3:51] As a pediatric resident, Dr. Shreffler had seen the burden of allergic disease, caring for kids in the Bronx with asthma. His interest in Th2 immunity, the clear and compelling unmet clinical need, and the problem of food allergy guided his career.   [4:31] Dr. Shreffler's wife has food allergies and they were concerned for their children. Fortunately, neither of them developed food allergies.   [5:21] Dr. Shreffler thinks the food allergy field has a lot of people who gravitate toward it for personal reasons.   [5:53] Food allergy is an adverse response to food that is immune-mediated. There is still uncertainty about this but Dr. Shreffler believes that a large percentage of patients with EoE have some triggers that are food antigens.   [6:27] The broad definition of food allergy would include things like food protein-induced enterocolitis syndrome (FPIES).   [6:47] The way we use the term food allergy in the clinic, there are two forms: IgE-mediated allergies and non-IgE-mediated allergies, including EoE.   [7:40] Some patients have food-triggered eczema, some have FPIES.   [8:04] In 2024, Dr. Shreffler and Dr. Caitlin Burk released a paper that looked at the triggers of EoE, particularly the intersection of IgE-mediated food allergy and EoE.   [8:41] Dr. Caitlin Burk joined the group as they were publishing papers on IG food allergy and EoE. It was a moment where things unexpectedly came together.   [9:17] Adaptive immunity to food proteins comes from antibodies that cause milk allergy, egg allergy, peanut allergy, or multiple allergies. The IgE has specificity.   [9:40] T cells also are specific to proteins. They express a host of receptors that recognize almost anything the immune system might encounter. They have a long memory like B-cells.   [10:09] The overlap in these two threads of research was regarding a population of T cells that are important for mediating chronic inflammation at epithelial sites, including the gut.   [10:36] These T cells have been described in the airways in asthma, in the skin in eczema, and the GI tract. Researchers years ago had also described them as being associated with IgE food allergy. People with IgE food allergies avoid allergens.   [11:13] T cells, being associated with chronic allergic inflammation, now being associated with food allergies which are not having chronic exposures to the allergen, was interesting and surprising.   [11:30] Dr. Shreffler and his group found the T cell subset in patients who don't do well with Oral Immunotherapy (OIT) and patients who have EoE with immediate symptoms.   [12:01] Dr. Shreffler notes differences. There are immediate symptoms of IgE food allergy. There is a subset of patients with EoE who have immediate symptoms that are not fully understood. Maybe IgE plays a role there.   [12:28] There are different mechanisms for how symptoms are caused and so different ways of making a diagnosis. A food allergy with an IgE antibody can be measured through skin tests and blood tests. This can help identify which foods are the trigger.   [12:57] This common T cell subset that we see in EoE and food allergy, helps to explain why IgE alone is not always a very specific marker for identifying people who will have immediate reactions when they're exposed to the food.   [13:17] For patients who react at low levels, it's not just that they have more or better IgE but they also have an expansion of these T cells that are common between EoE and other chronic forms of allergy and IgE food allergy.   [13:41] There's a lot to learn that might be relevant for patients about this T cell subset.   [14:23] These T cells are a specific subset of the group of Th2 T cells, which are a subset of all CD4 T cells. Some CD4 T cells are important for responding to viruses and tumors. Others are important for responding to outside allergens.   [15:01] In an allergy or a parasite infection, Th2 T cells are important. There is a subset of T cells that is driven by repetitive and chronic exposure to the triggering protein, antigen, or allergen.   [15:47] Most antigens are proteins that trigger an immune response. An antigen that elicits an allergic response is an allergen. [16:30] A food trigger is a protein antigen that is an allergen. In IgE, food allergies, milk, and eggs are prevalent triggers early in life. For reasons not well understood, a lot of people outgrow them. In older patients, peanut and tree nut allergies are prevalent.   [17:01] In EoE, milk is one of the most common dietary triggers into adulthood. Some patients with IgE allergy to milk can tolerate it if it's well cooked. Patients with EoE are less likely to be able to get away with regular and ongoing exposure to milk protein.   [17:54] Milk, eggs, and nuts are common triggers in both conditions. There can also be rare food allergy triggers. That's part of the early evidence that the adaptive immune response was likely to be involved. It can be so specific for some people to rare things.   [18:20] Hallmarks of something being immune-mediated are that it is reproducibly demonstrable as a trigger. It's going to be long-lived. It's going to be generally relatively small amounts. The immune system is good at detecting small exposures.   [19:07] EoE is tricky because there's not that clear and easy temporal association between an offending allergen exposure for most people and their symptoms. People don't associate the symptoms with the triggers.   [20:14] A history of having blood in the stools can be milk-allergen-driven and was associated with a diagnosis of EoE in those kids when they're older.   [20:26] There are a lot of commonalities in the allergens but it's not always obvious clinically.   [22:40] A challenge in diagnosing EoE is that providers have to be on guard against their biases. They have to give a patient good advice. In EoE there is no test to identify triggers, except rigorous introduction, elimination, reintroduction, and endoscopies.   [24:18] For some of Dr, Shreffler's patients, it becomes less important to know their dietary triggers. They gravitate toward an approved form of treatment that may, if successful, allow them to have a more normal diet because of effective medication.   [24:50] Dr. Shreffler thinks there are other triggers, including pollens. There is evidence of seasonality of active EoE in patients shown to have allergic sensitization to pollens. That's indirect evidence. If the body is making IgE, it's likely making other responses.   [25:32] There are questions about how large the population of patients is who have EoE that may be more intrinsically than extrinsically driven because of genetic variations.   [25:54] Dr. Shreffler believes that EoE in some patients is allergen-driven and in some patients EoE is food-driven. Food is a trigger for the majority of pediatric patients and a large percentage of adult patients but not necessarily the exclusive trigger.   [27:04] If a patient is motivated to learn what dietary triggers may be at play, Dr. Shreffler often makes assessments outside of pollen season for allergens to which the patient has demonstrated positivity.   [28:09] Looking at the epidemiology, both EoE and food allergy are atopic disorders. You see an increased prevalence of asthma, hay fever, eczema, and even allergic proctocolitis in infancy. You see an enrichment of one disorder to another.   [28:29] The overlap of food allergy to EoE is stronger than you might expect. About 30 to 40% of patients with EoE will also have IgE food allergy. A higher rate will have IgE positivity, whether or not that food is a trigger of immediate symptoms.   [28:48] Patients with food allergies are about four times more likely to have EoE than the general population. That's a stronger association than the risk of eczema or other atopic conditions to EoE.   [30:09] There are differences between IgE food allergy and EoE. The presence of IgE gives a useful tool for identifying the food trigger in food allergy, but not in EoE. Identifying rare triggers in EoE patients is done by clinical observation.   [31:46] Epinephrine and antihistamines are not useful in treating EoE. Blocking IgE with Omalizumab has not been effective in trials in treating EoE. PPIs, topical steroids, and dupilumab are helpful for many EoE patients.   [32:38] Dupilumab has been evaluated a bit in food allergy in combination with OIT, and there was no statistically significant benefit from dupilumab in food allergy.   [33:25] A group in Pennsylvania has been evaluating epicutaneous immunotherapy as a modality to treat EoE. It's also being evaluated for IgE food allergy. Dr. Shreffler thinks it's something to keep an eye on.   [33:40] The oral route for immunotherapy can drive EoE for patients. As they become less sensitive from an immediate reactivity viewpoint, a significant percentage of patients develop GI symptoms. This has also been observed with sublingual therapy.   [34:14] Iatrogenic EoE, caused by the treatment, may resolve on the cessation of the immunotherapy treatment.   [36:25] Dr. Shreffler says in some cases, the shared decision is a decision where he has a strong evidence-based opinion. In some cases, there's a lot more room for a range of clinical decisions that could be equally supported by what we know right now.   [36:57] We've said that EoE is a contraindication for OIT. There is a shift happening. Dr. Shreffler sits with families and has a conversation about restricting diet or trying chronic therapy and keeping an ad-lib diet.   [37:38] What about doing the same thing by treating the immediate-type food allergy with chronic allergen exposure and then ameliorating the effects of EoE if it emerges, with another therapy? A hundred providers would have a diversity of responses.   [38:19] When there is a history of EoE in a family, Dr. Shreffler advocates for getting a baseline scope. It becomes an important “ground zero.”   [38:28] The goal is to have less invasive ways to monitor these conditions.   [39:32] Chronic inflammation, which is the hallmark of EoE, is well-targeted by therapies like PPIs and steroids. Steroids don't help with IgE-related food allergies. They're not effective at blocking the IgE-driven immediate response.   [41:13] Until recently, IgE food allergy has only been managed with avoidance. We have some other tools now. Xolair is not effective in EoE but is effective in two-thirds to three-quarters of patients with immediate-type food allergies for preventing anaphylaxis.   [41:45] Dr. Shreffler refers to an upcoming study on the effectiveness of Xolair in treating people with food allergies. Those who were able to tolerate a minimum amount were allowed to begin consuming allergen. We'll get insight into how those patients did.   [43:08] Food-induced immediate response of the esophagus (FIRE) is immediate discomfort with exposure to some allergens. Dr. Shreffler explains it. Data supports that these patients are experiencing an IgE-mediated but local response to those triggers.   [44:59] If FIRE is IgE-mediated, it may be that Xolair would help suppress it in these patients. It's worth looking at Xolair for this subset of EoE patients.   [45:20] Ryan invites any listeners who want to learn more about FIRE to check out episode #34 with Dr. Nirmala Gonsalvez.   [45:37] In the paper, Dr. Shreffler wrote about what he hopes will be the practical usefulness of the finding, the intersection between IgE food allergy and EoE.   [45:56] A subset of Th2 T cells express a protein called GPR15. It appears to be a marker for the subset of cells that are playing a role in the EoE.   [46:36] Caitlin Burk's work now is looking at their activation status in active disease and post-diet elimination and remission. She is developing a data set that is leading us toward the possibility of focusing on that cell subset and techniques to adopt in clinics.   [47:12] She is also working out more advanced techniques to look at the receptors. Dr. David Hill at CHOP is working on similar research. This research has the potential to lead to the development of better tests for EoE.   [47:44] Holly tells Dr. Shreffler this has been such an informative episode with so many tidbits of things to help patients advocate for themselves. Holly thanks him for sharing all of that.   [48:12] Dr. Shreffler is trying to see what can be utilized from their research to make non-invasive tests to identify food allergen triggers for patients so they don't have to go through so many endoscopies. He sees it as a huge unmet need.   [48:31] Ryan thanks Dr. Shreffler for joining us. For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [48:41] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [48:50] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [49:00] Ryan thanks Dr. Shreffler for joining us today for this interesting conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. Wayne Shreffler, MD, Ph.D., Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital “Triggers for eosinophilic esophagitis (EoE): The intersection of food allergy and EoE” Dr. Caitlin Burk Dr. David A. Hill   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “This fascinating problem of food allergy: why does the immune system do that for some people — recognize what should be nutritive and innocuous sources of energy as an immunological trigger? ” — Dr. Wayne Shreffler   “A food allergy; because there is this IgE antibody, we can do skin tests. We can measure that in the blood. It's a useful marker for helping to identify which foods are the trigger.” — Dr. Wayne Shreffler   “EoE is tricky because there's not that clear and easy temporal association between an offending allergen exposure for most people and their symptoms. People don't associate the symptoms with the triggers.” — Dr. Wayne Shreffler   “Everything is shared decision-making. In some cases, it's a shared decision where I have a strong evidence-based opinion. In some cases, there's a lot more room for a range of clinical decisions that could be equally justified.” — Dr. Wayne Shreffler   “Steroids don't help with IgE-related food allergy. They're not effective at blocking that IgE-driven immediate response.” — Dr. Wayne Shreffler   “I'm trying to see what we can utilize from our research to make non-invasive tests to identify food allergen triggers for patients so they don't have to go through so many endoscopies. I think that's a huge unmet need.” — Dr. Wayne Shreffler  

Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities.Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Wednesday at 7 AM. Leah discusses eosinophilic esophagitis (EoE) and its potential connection to VA disability claims, particularly for Gulf War veterans. She explains EoE as a chronic immune system disease where eosinophils, a type of white blood cell, accumulate in the esophagus, often due to allergens, causing inflammation and damage. Leah highlights the complexity of linking EoE to Gulf War exposures, emphasizing the role of allergens and immune responses potentially triggered by environmental factors like burn pits. She reviews relevant medical literature and encourages veterans with EoE to explore service connection possibilities, especially if the condition developed during or after service.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/AFA865. CME/MOC/AAPA credit will be available until January 30, 2026.A Collaborative Approach to Identifying Eosinophilic Esophagitis in the ED: Emergency Presentation, Timely Diagnosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc. and Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/AFA865. CME/MOC/AAPA credit will be available until January 30, 2026.A Collaborative Approach to Identifying Eosinophilic Esophagitis in the ED: Emergency Presentation, Timely Diagnosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc. and Sanofi.Disclosure information is available at the beginning of the video presentation.

In this episode, hosts Drs. Temara Hajjat and Jenn Lee talk to Dr. Rachel Chevalier. Dr. Chevalier is a pediatric gastroenterologist and physician scientist at Children's Mecy Hospital. She is an Associate Professor at the University of Missouri-Kansas City School of Medicine. In this episode, we'll explore treatment options for eosinophilic esophagitis, discuss steroid complications and emerging therapies, and dive into the role of drug metabolism and genetics in optimizing patient care. Learning Objectives:Discuss available corticosteroid options, dosing strategies, administration techniques, and challenges like insurance coverage and FDA limitations.Highlight potential complications of steroid use, mitigation strategies, and emerging treatments like orodispersible tablets.Explain the role of CYP enzymes, genetic variability, and personalized approaches to optimize treatment based on Dr. Rachel Chevalier's research.Support the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

In this episode, the Turd Nerds discuss Eosinophilic Esophagitis (EOE), exploring symptoms, diagnostic testing, and treatment approaches. The conversation delves into dietary interventions, the role of histamine in gastrointestinal health, and the importance of comprehensive diagnosis in managing EOE. The episode highlights the evolving understanding of EOE and the potential for integrative treatment options.

In this episode, the hosts discuss Eosinophilic Esophagitis (EOE), a condition that has gained recognition in recent years. They explore its symptoms, including dysphagia and food impaction, and the importance of accurate diagnosis through endoscopy and biopsies. The conversation delves into risk factors, potential triggers such as food allergies, and the role of diet in managing EOE. Treatment options are discussed, including pharmaceutical interventions like Budesonide and PPIs, as well as dietary management strategies such as elimination diets. The hosts also touch on herbal remedies and the importance of monitoring for fungal overgrowth during treatment.

WSJ: Trump nominees 'hawking' supplements?Correction on Surgeon General Nominee Dr. Janette Nesheiwat's husbandI have chronic fatigue. Do you think I would benefit from taking a copper supplement?Can I take garlic pills to help my eosinophilic esophagitis?

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/EBAC/MOC information, and to apply for credit, please visit us at PeerView.com/QQD865. CME/EBAC/MOC credit will be available until December 13, 2025.Improving Care for Pediatric and Adult Patients With Eosinophilic Esophagitis: Expert Insights on the Latest Evidence for Targeted Therapy In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Sanofi and Regeneron Pharmaceuticals.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/EBAC/MOC information, and to apply for credit, please visit us at PeerView.com/QQD865. CME/EBAC/MOC credit will be available until December 13, 2025.Improving Care for Pediatric and Adult Patients With Eosinophilic Esophagitis: Expert Insights on the Latest Evidence for Targeted Therapy In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Sanofi and Regeneron Pharmaceuticals.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/EBAC/MOC information, and to apply for credit, please visit us at PeerView.com/QQD865. CME/EBAC/MOC credit will be available until December 13, 2025.Improving Care for Pediatric and Adult Patients With Eosinophilic Esophagitis: Expert Insights on the Latest Evidence for Targeted Therapy In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Sanofi and Regeneron Pharmaceuticals.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/EBAC/MOC information, and to apply for credit, please visit us at PeerView.com/QQD865. CME/EBAC/MOC credit will be available until December 13, 2025.Improving Care for Pediatric and Adult Patients With Eosinophilic Esophagitis: Expert Insights on the Latest Evidence for Targeted Therapy In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Sanofi and Regeneron Pharmaceuticals.Disclosure information is available at the beginning of the video presentation.

In the final installment of our EoE FAQ series, Dr. Pooja Singhal discusses the critical role of endoscopy in diagnosing and managing Eosinophilic Esophagitis. Learn why this procedure is essential for identifying EoE and other digestive conditions, what to expect during an endoscopy, and what healthcare providers are looking for. Dr. Singhal also explains the importance of follow-up endoscopies in monitoring treatment progress and patient outcomes. Sponsored by Sanofi Regeneron, this episode is a must-listen for anyone seeking a deeper understanding of EoE care and monitoring.

In Part 2 of our EoE FAQ series, Dr. Pooja Singhal answers your top questions about medications for managing Eosinophilic Esophagitis. What are proton pump inhibitors (PPIs), steroids, and biologics? How do these medications work, and how can they help alleviate EoE symptoms? Dr. Singhal also highlights the importance of a collaborative process between patients and healthcare providers in selecting the most effective treatment plan. Sponsored by Sanofi Regeneron, this episode offers a clear and insightful look into EoE medications and their role in treatment.

We've received so many questions about Eosinophilic Esophagitis (EoE) that we're bringing you a special 3-part FAQ series with one of the top experts in the field, Dr. Pooja Singhal, a leading gastroenterologist and founder of Oklahoma Gastro Health and Wellness. In this episode, Dr. Singhal breaks down why EoE is often mistaken for a common food allergy, the key differences between the two, and the crucial role specialists play in managing EoE symptoms. Don't miss this insightful discussion, sponsored by Sanofi Regeneron.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/PUG865. CME/MOC/AAPA/IPCE credit will be available until November 20, 2025.Early Diagnosis and Evolving Management of Eosinophilic Esophagitis in the Era of Targeted Therapy In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc and Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/PUG865. CME/MOC/AAPA/IPCE credit will be available until November 20, 2025.Early Diagnosis and Evolving Management of Eosinophilic Esophagitis in the Era of Targeted Therapy In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc and Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/PUG865. CME/MOC/AAPA/IPCE credit will be available until November 20, 2025.Early Diagnosis and Evolving Management of Eosinophilic Esophagitis in the Era of Targeted Therapy In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc and Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/PUG865. CME/MOC/AAPA/IPCE credit will be available until November 20, 2025.Early Diagnosis and Evolving Management of Eosinophilic Esophagitis in the Era of Targeted Therapy In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc and Sanofi.Disclosure information is available at the beginning of the video presentation.

Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities.Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Wednesday at 7 AM.In this episode, Leah discusses Eosinophilic Esophagitis and Gulf War Veterans.

Please visit answersincme.com/WSK860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, Evan S. Dellon, MD, MPH, an expert in esophageal disease, discusses best practices to facilitate timely diagnosis of eosinophilic esophagitis (EoE) through symptom recognition and referral at the emergency department. Upon completion of this activity, participants should be better able to: Recognize the consequences of untreated eosinophilic esophagitis (EoE), including the burden of food impaction; Identify best practices to facilitate the timely diagnosis and management of EoE through symptom recognition and referral; and Review the available therapeutic modalities for EoE that support the need for timely referral. This activity is intended for US healthcare professionals only.

Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Mary Jo Strobel, APFED's Executive Director, interview Kate Goncalves about her diagnosis and treatment journey with EoE.   In this episode, Ryan and Mary Jo discuss with Kate Goncalves how she lived with her symptoms for years before finally bringing them to the attention of her primary care physician at age 16, and how she was connected with a gastroenterologist and diagnosed with EoE. Kate discusses her transition from pediatric to adult care, and how she and her care team prepared for her to travel to go to college. They talk about her treatment plan of eliminating milk and using medications, and how it is a challenge to navigate EoE during the long days on her college campus. Kate also talks about the EoE research project she is working on as part of her pre-med studies, and shares advice for people living with EoE and going away to college. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Ryan Piansky introduces the episode, brought to you thanks to the support of education partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron, and co-host, Mary Jo Strobel.   [1:31] Mary Jo introduces Kate Goncalves, a 20-year-old living with EoE. Kate is the 2024 recipient of The APFED Abbott College Scholarship, thanks to a grant from Abbott, the makers of the EleCare®  brand elemental formula.   [2:05] Kate is from a small town in Connecticut. She is a junior at Vanderbilt University, studying biology and anthropology. She grew up with day-to-day symptoms of EoE but only expressed the symptoms to her doctor when she was 16 years old.   [2:23] At that point, she underwent testing and was diagnosed. Since then she has been trying to find a treatment plan that works for her. She has navigated changes in her treatment plan while going away to college. She comments that, in college, you don't always have control over the food you eat.   [2:42] It has been a challenge but she has a great support system and care team.   [3:15] In middle and high school, Kate got a food impaction nearly every day at lunch. She thought it was normal. When she finally brought it up to her primary care physician, the doctor suspected EoE. She also had the symptoms of heartburn or acid reflux.   [4:15] Kate immediately had an endoscopy scheduled and was then diagnosed with EoE.   [4:22] Prior to a diagnosis, Kate coped with symptoms by  drinking “a ton” of water with foods to help them go down her esophagus, which was narrowed from scarring. She also avoided bread and meats. She only recognized these as adaptive behaviors after she was diagnosed.   [5:32] Kate was referred to a gastroenterologist. That doctor is still part of Kate's care team. She also saw a nutritionist when looking for a treatment plan that worked for her.   [6:02] Kate avoids anything with dairy in it. Her elimination diet removed anything made with butter, milk, yogurt, and more. At her follow-up endoscopy, her eosinophils were way down so she didn't have to go through the six-food elimination diet. She was very grateful.   [6:43] Mary Jo clarifies for listeners who may not be familiar with the six-food elimination diet, that the foods removed from the diet are typically  milk, egg, wheat, soy, peanut/tree nut, and fish/shellfish.   [7:05/] Kate says it was a tough transition because more foods than you might expect have milk in them. She is grateful she didn't have to cut out gluten or nuts.   [7:32] Kate admits that sometimes she knows there is dairy in the food and eats it anyway. Then the symptoms are most often severe acid reflux and heartburn. She'll get a food impaction if she's been eating dairy for days or a lot of it at once.   [8:35] At school, sometimes the dining hall workers aren't aware if a food has dairy in it.  Some foods are mislabeled as vegan. So Kate often has dairy without knowing it until symptoms appear later.    [9:12] Kate is on a proton pump inhibitor twice a day and a steroid medication. Her first treatment was the elimination of dairy. The summer before going to college, she was also put on these two medications, in case she was exposed to dairy.   [10:50] Kate had to switch from one steroid medication to another because the first one wasn't working for her varying schedule. She asked her doctor for another medication that fit her schedule better.   [11:31] Kate is very grateful to feel autonomy over her treatment plan. She feels her gastroenterologist is amazing. Kate is always free to give feedback about how she is feeling.   [11:46] Kate feels a more present role in her medical appointments now, versus before she was diagnosed. Both with her gastroenterologist and her primary care physician, she has learned to be comfortable being forward and truthful with her doctors.   [13:16] For patients who have not learned to speak up to their care team, Kate suggests being patient. It takes time to get used to the structure of appointments, follow-up appointments, and appointments with a new doctor.   [13:25] When Kate transitioned from her pediatrician to her adult doctors it took her a while to become comfortable with her gastroenterologist and her primary care physician. Don't be afraid to pose questions and concerns, even questions about other treatment plans.   [13:56] Your doctors are there to listen to you and to help you, and you can only gain from bringing something up to your doctor that you are afraid to bring up or that you aren't sure how the conversation is going to go.   [14:47] Kate explains how she tells her friends about her EoE triggers and symptoms and what eosinophils do to her esophagus. Most of her friends study biology and the immune system, so they can understand her condition and needs.   [16:12] EoE impacts Kate's social life. Kate sometimes sits out of activities involving dinners or events with food present. She doesn't want to be exposed to a trigger food. She has also missed events and activities due to hospital visits and appointments.   [16:37] If Kate is having a flare-up of her symptoms, she will also miss activities. All these things lead to feelings of exclusion. No one she knows has EoE. [16:55] Because of her treatment plan and her medications, Kate's symptoms are somewhat limited so she can participate in activities as she chooses.   [17:14] Kate's advice for people who know someone with EoE is to be open-minded. EoE is kind of an invisible disorder. People often think that being allergic to dairy is lactose intolerance, which it is not. Do some research about EoE and its effects. Offer support. [17:42] A patient has a care team whose job is to care for them. When family and friends include you and care for you, it's a very different feeling. As a friend, be patient and offer any support you can. [18:34] When Kate travels, her best tool is communication. Informing food service staff about your allergy is the easiest way to ensure that the food you eat is safe. Kate does lots of research when she travels. This includes looking on restaurants' websites for dietary restrictions.   [20:43] Kate prepared for college by making sure she had a full semester supply of medications and ensuring that she was in close contact with her medical care team over the phone and through MyChart.   [21:19] She made plans with her gastroenterologist to make sure that if anything did come up or if the treatment plan wasn't working in the college setting, they would talk it through when it was needed and not wait until she was home for Thanksgiving.   [21:54] Kate is thankful she chose a school that was connected to a hospital. She feels more safe and prepared for a bad food impaction. She knows she can seek medical attention and have a team on-site very soon.   [22:43] The quality of the dining at the college was a factor in Kate's choice of schools. Vanderbilt has a dining hall completely free of the eight main allergens. When she eats there, she knows that the food she is eating will be safe, without having to ask.   [23:34] For people living with an eosinophilic disorder like EoE, Kate has two tips about preparing to go away to college. First, don't feel limited by your disorder. At first, Kate was afraid of being far away from her care team, but she couldn't be happier now.   [23:56] At college, there are resources and counseling to help you. Being away from home has taught Kate to be responsible as an adult for the treatment of her disorder. So, second, use college as an opportunity to gain responsibility in treating your disorder.   [25:11] Kate is working in a biomedical engineering lab at Vanderbilt University that is researching a way to diagnose and monitor EoE using saliva. They use Raman Spectroscopy to look for biomarkers in saliva from people with EoE, not found in the saliva of healthy people.   [25:51] A successful test would be less costly and quicker than an endoscopy with anesthesia. It would provide a point-of-care diagnostic that would lower the cost and increase the efficiency for patients.   [28:09] Raman Spectroscopy is a form of spectroscopy that measures the vibrational frequencies between chemical bonds. It reads the composition of biological samples. It can tell the amounts of lipids, proteins, or amino acids.   [26:37] The lab is researching the differences in the saliva of people with EoE from the saliva of healthy people. If they can find a difference, and if that difference is universal, we might be able to diagnose EoE using Raman Spectroscopy.   [26:55] Kate says that would be awesome because the anesthesia of endoscopy is “a lot”, every time.   [27:09] Kate is on the pre-med track, which includes doing research. She wanted her research to be on something that she cared about. She is happy to be at a school that is a top research institution.   [27:48] When she learned of this biomedical engineering lab researching ways to diagnose EoE, she immediately reached out to the Principal Investigator and was invited to join. She has been a part of the lab for over a year and it's been an amazing experience!   [28:15] Before going to medical school, Kate plans to take one or two gap years after she graduates so she can further her research with EoE or with other eosinophilic disorders. She would love to see advancements in the field.   [29:16] Kate finds that the most challenging part of living with EoE is feeling lonely, She has never met anyone else with EoE. No one knows what it is when she first explains it to them. It's not a super common disorder.   [29:35] Because EoE is a rare condition, Kate doesn't have much of a community around it in her life. She was excited to learn about and connect with APFED through social media. Even so, it is easy to feel alone in her personal life.   [29:54] Kate doesn't want to have to worry constantly about her food or when to take her medications. She wants to live like a normal, healthy college student, but she can't. Sometimes she doesn't take her disorder as seriously as she should.   [30:25] Sometimes Kate will have that ice cream because everyone else is having it. She wants to live as though she doesn't have EoE. Navigating that without a community that relates to her struggle has been a challenge.   [30:51] Kate's parents, siblings, and friends support her, but it's not the same as having someone who completely understands and is going through it. She feels lonely.   [32:24] Kate says that awareness is super powerful. She went 16 years without knowing she had EoE. She wasn't educated on it. She is sure there are many living with untreated EoE just as she was.   [32:42] Kate encourages anyone listening to spread awareness for eosinophilic research. People are struggling with it. Kate was super excited to come on the podcast today to share her story with anyone in college who might be struggling with EoE.   [33:05] Kate says, if you're struggling with eosinophilic disorders, you're not alone. I'm there, too! She encourages listeners to continue to spread awareness and advocate for eosinophilic disorders.   [33:13] Ryan and Mary Jo thank Kate Goncalves for joining the podcast episode to share her story and help spread awareness.   [33:19] For our listeners who would like to learn more about EoE, please visit APFED.org/EOE. If you're looking to find a specialist who treats EoE, you can use APFED's Specialist Finder at APFED.org/specialist.   [33:40] Kate thanks Ryan and Mary Jo for this opportunity.   [33:43] Mary Jo also thanks Bristol Myers Squibb, GSK, Sanofi, and Regeneron, APFED's Education Partners who supported this episode.   Mentioned in This Episode: APFED College Scholarship Abbott EleCare Elemental Formula MyChart   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “I go to school halfway across the country so I don't have close access to my care team and support. … Knowing I was going to be exposed to some dairy, my GI doctor thought it was best to put me on the steroid medication.” — Kate Goncalves   “Your doctors are there for you. They're there to listen to you and to help you and you can only gain from bringing something up to your doctor.” — Kate Goncalves   “Feeling support from family and friends… you feel so included and cared for. Feeling that from friends versus feeling that from your care team… they're very different. Your care team cares about you but that's their job.” — Kate Goncalves   “I think anyone with a chronic illness would relate to this. I just turned 20 and I'm in college. I don't want to constantly worry about the food I'm eating and when to take my medications. I want to live like my friends.” — Kate Goncalves

Send us a textEver wondered what's behind that persistent difficulty swallowing or chest discomfort? On this episode of MedEvidence, Dr. Yuval Patel uncovers the mysteries of eosinophilic esophagitis (EOE), an often-misunderstood chronic allergic condition. We'll take you through the role of eosinophils, the specific white blood cells responsible for allergic reactions, and how their infiltration into the esophagus can lead to painful inflammation and food pipe narrowing. Our conversation expands to the “three Ds” of EOE treatment: drugs, diet and dilation. You'll gain a comprehensive understanding of first-line treatments while we also highlight the crucial role of dietary changes. We wrap up by discussing the vital importance of personalized treatment plans and groundbreaking clinical trials. Don't miss this chance to understand the long-term prognosis and the vital management strategies needed to prevent complications in EOE patients. Join us for an enlightening journey through the complexities of eosinophilic esophagitis!Talking Topics:Understanding Swallowing DifficultyTreatment Options for Eosinophilic EsophagitisManaging and Treating Eosinophilic EsophagitisAdvancements in EOE TreatmentRecording Date: August 7, 2024Be a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on AppleWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedInWant to learn more checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

Eosinophilic Esophagitis (EOE) is an allergic condition in the esophagus that often goes undiagnosed for up to 10 years. In the last two years since we first covered EoE, new treatment options are now available for this chronic condition. Gastroenterologist Dr. Milli Gupta returns to help us understand the new treatment options and explain what patients need to know in preparation for discussing their options with their healthcare provider. This episode provides a basic overview of EoE, including the signs and symptoms a person may experience, such as trouble swallowing, food impaction, and the adaptive behaviors at mealtime, that signal it's time to seek medical attention. This episode is brought to you by Sanofi Regeneron.

We welcome back Dr. Evan Dellon from the University of North Carolina School of Medicine at Chapel Hill to discuss the latest advances in research and treatment options for Eosinophilic Esophagitis. In this episode we discuss several of the standout abstracts we found extremely encouraging for patients living with an EoE diagnosis that were presented at this year's Digestive Disease Week (DDW), an annual scientific conference. This episode is brought to you by Sanofi Regeneron. 

PayerTalkCE™ Presents: Managing Eosinophilic Esophagitis (EoE): Collaborative Care and the Patient Journey Embark on an enlightening journey through the complex world of eosinophilic esophagitis (EoE) management. Join host Dr. Steve Kheloussi (Highmark, Inc.), alongside experts Mary Jo Strobel (American Partnership for Eosinophilic Disorders, and Dr. Evan Dellon (University of North Carolina at Chapel Hill), as they unravel the intricacies of the patient journey with EoE. This episode delves deep into the challenges of diagnosing EoE, the significant impact of delayed diagnosis, and the innovative approaches to collaborative care. Discover the evolving recommendations that are shaping the future of EoE management and how multidisciplinary teams are working to improve outcomes for patients. This insightful discussion offers a comprehensive look at the efforts to enhance the quality of life for those affected by EoE, emphasizing the importance of timely intervention and ongoing monitoring. This activity is certified for CME/CNE/CPE credit. To participate and earn credit, visit us at https://www.impactedu.net/payertalkjourney/. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Holly Knotowicz, a speech-language pathologist living with EoE, who serves on APFED's Health Sciences Advisory Council, have a conversation about food-induced immediate response in eosinophilic esophagitis (EoE), with guest Dr. Nirmala Gonsalves, Professor of Medicine in the Division of Gastroenterology and Hepatology at Northwestern University, Feinberg School of Medicine, and Co-Director of the Northwestern Eosinophilic Gastrointestinal Disorders Program.   In this episode, Ryan, Holly, and Dr. Nirmala Gonsalves discuss food-induced immediate response in EoE, recent and ongoing research into FIRE, and advice for providers.   Listen to this episode to learn about food-induced immediate response (FIRE). Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Ryan Piansky and co-host Holly Knotowicz introduce the topic of today's episode, food-induced immediate response in eosinophilic esophagitis, and their guest, Dr. Nirmala Gonsalves, Professor of Medicine in the Division of Gastroenterology and Hepatology at Northwestern University, Feinberg School of Medicine.   [1:38] Dr. Gonsalves is the Co-Director of the Northwestern Eosinophilic Gastrointestinal Disorders Program. Her research and clinical career are dedicated to improving the care of patients with eosinophilic gastrointestinal diseases, or EGIDs.   [1:53] Dr. Gonsalves's extensive clinical experiences with EGIDs have shaped her research goals, which include identifying novel treatments and determining the best methods to measure disease activity.   [2:20] Dr. Nirmala Gonsalves has been at Northwestern for 25 years and has been involved in the EGID and EoE space for the last 20 years. Dr. Gonsalves met Ryan during her first introduction to APFED when Ryan was “much, much younger,” so she is pleased to see him co-hosting this podcast.   [2:56] Within Northwestern Medicine, Dr. Gonsalves is part of the Esophageal Group. Within the Esophageal Group, she co-directs the Eosinophilic GI Disorders Program with Dr. Ikuo Hirano. Working in the EGID space for the last 20 years has been incredibly rewarding.   [3:11] Dr. Gonsalves feels lucky to be a part of The International Gastrointestinal Eosinophil Researchers (TIGERS) and the Consortium of Eosinophilic and Gastrointestinal Disease Researchers (CEGIR).   [3:26] Dr. Gonsalves has focused her clinical career on understanding eosinophilic GI disorders, helping to get better diagnoses, increased awareness, and better treatments, and improving the quality of life for patients with these conditions.   [4:19] Dr. Gonsalves describes the study of food-induced immediate response in eosinophilic esophagitis (FIRE). In 2017, gastroenterologist Dr. Alex Straumann, and allergist Dr. Mark Holbreich, both very familiar with EGID, started a multi-center effort and project, working with many physicians and patients to define this condition of FIRE.   [4:45] The symptoms of FIRE are very different from what we typically think about as EoE symptoms. The classic symptoms of EoE in adults are dysphagia (difficulty swallowing), or food impaction (a bolus of food stuck in the esophagus).   [5:37] This team of researchers in Switzerland, Northwestern, Indiana, North Carolina, Colorado, and Mt. Sinai, to name a few centers, noticed patients describing different symptoms; a more immediate response that was happening in their esophagus when they were exposed to certain specific foods, like beer or wine and avocado or banana.   [6:19] Patients described an immediate reaction in their esophagus, occurring any time from seconds to minutes after ingesting that food, as a painful, squeezing sensation, and a narrowing in their esophagus that was temporally related to these foods.   [6:42] It started to increase the researchers' awareness that this symptom was different from the classic dysphagia that adults and older children typically present with.   [7:12] In the study, they did a two-phased investigation. First, they sent a survey to physicians used to treating EoE, to understand what their experience was about these symptoms. Based on that knowledge, they convened twice to develop a questionnaire for patients, to understand how common this is in the patient population.   [7:38] The response was 47 physicians (an 82% response rate). They sent the patient survey to the EoE Swiss cohort and the response was 239 patients (a 65% response rate.)   [7:58] Of the physicians, 90% reported patients reporting these symptoms. The physicians estimated this to occur in 5 to 20% of EoE patients. Looking at the patients who had FIRE with EoE, vs. EoE without FIRE, the FIRE patients were younger and more likely to have other atopic conditions like rhinitis, asthma, and dermatitis.   [8:42] Patients with FIRE were more likely to have had a prior food impaction, a longer duration of disease, and a longer time to symptom presentation. Those were the risk factors in the patients.   [8:56] In the patient questionnaire, 40% of the EoE patients surveyed reported that they had symptoms of FIRE. [9:29] Most of the patients in the study were adult patients. Looking at the average age of the EoE cohort vs. the EoE with FIRE cohort, the EoE with FIRE patients tended to be younger. Dr. Gonsalves suspects that patients are experiencing FIRE earlier on, but they don't know what is occurring. [9:56] Dr. Gonsalves thinks that is where the investigation is going: to understand when FIRE is happening. The symptoms are quite different than the typical first EoE symptom when something is going down slower or getting caught in the esophagus.   [10:27] As far as whether FIRE is experienced by other patients besides EoE patients, the survey team only noticed FIRE in EoE patients. A follow-up study could look at the control cohort or the regular reflux cohort. Patients don't express these types of symptoms, other than EoE patients, so it seems unique to EoE patients.   [10:53] When the team talked about and tried to understand more about the background of FIRE, and the risk factors, they wondered if it was similar to oral pollen syndrome, with a more immediate reaction in the esophagus.   [11:49] With adults, certain liquors, wines, beers, avocados, and bananas stand out among triggers. The symptoms are so significant that patients would say on a scale of one to ten, it's a seven intensity. It's fairly immediate, within seconds to minutes, with a duration of minutes to several hours.   [12:18] A lot of times, patients compensate by not eating those specific foods because they don't want that condition to happen. For some patients, it's a profound spasm-type squeezing in their chest that will occur when this happens.   [13:44] Dr. Gonsalves says many patients will confuse FIRE with an anaphylactic reaction; it's not clear what it is. The multidisciplinary group of physicians that worked on this study included allergists and gastroenterologists all tried to come up with the mechanism that causes FIRE. It does not appear to be an anaphylactic reaction.   [14:13] When FIRE occurs, the doctors of the multidisciplinary group ask their patients to seek care from their allergist and discuss this with their allergist, to get more testing and understanding of what's occurring. They want to be mindful if there's any risk of anaphylaxis, but it does not appear that the FIRE condition is related to anaphylaxis.   [14:55] Dr. Gonsalves says we're at the very early stages of understanding the mechanisms of why FIRE is occurring. The first step was to increase awareness, define FIRE, understand it, and separate it from both EoE symptoms and anaphylaxis. We don't yet understand the mechanisms.   [15:18] At Northwestern, they are looking at a study to define FIRE better. They look to see if there is IgE sensitivity to these foods. If there are not, they look to see if there are any nanometric changes in the esophagus when these foods are in the esophagus. Are people having the esophageal spasms that equate to the symptoms they describe?   [16:03] That study is to understand more about the mechanisms causing FIRE. What happens to the FIRE symptoms? Once a physician treats a patient with EoE, the FIRE gets better. Patients sometimes can reintroduce the foods when their EoE is quiet. There is a short window of time to identify FIRE in a patient before treatment.   [16:43] Early identification and early treatment is the mantra. They don't want to delay treatment in any patient. When the EoE goes in remission from treatment, the FIRE symptoms tend to go into remission, also.   [17:01] This is unpublished data and research they are working on. Hopefully, they will learn more and be able to share it with APFED. These are their speculations.   [18:17] At Northwestern, they are known for dietary therapy. Their patients gravitate toward diet therapy. The foods involved in FIRE symptoms are not big EoE triggers. In dietary therapy, when foods are reintroduced, patients describe recurrent dysphagia, heartburn, and EoE-type symptoms.   [18:56] Patients having foods reintroduced don't typically describe this immediate reaction where their esophagus is spasming, contracting, and feeling very tight right after. That's a very different symptom.   [19:17] For the patients studied, the foods most consistently triggering FIRE symptoms were fruits, wines, vegetables, honey, beers, and vinegar. The foods driving FIRE tend to be the foods driving oral allergy but the symptoms are different; no mouth, tongue, or lip itching, but a squeezing sensation in the esophagus.   [20:29] Dr. Gonsalves says they have not identified long-term consequences of FIRE. They are very early in the stages of understanding and following it. The long-term consequences come from untreated EoE. Dr. Gonsalves lists some consequences of untreated EoE, including worsening scarring, strictures, and dysphagia.   [21:08] Dr. Gonsalves speculates and wonders if physicians were sometimes confused between dysphagia, oral-pollen allergy symptoms, and FIRE symptoms, without it being clear what the patient was experiencing, leading to a delay in diagnosis.   [21:52] Dr. Gonsalves says having patients with FIRE symptoms highlights the importance of having a multidisciplinary program and having a good collaboration with allergists, dieticians, and GI health psychologists to address food fear and anxiety, pathologists, and pediatricians. It's important to have conversations with colleagues.   [22:31] Dr. Gonsalves says there's no test for FIRE, which is why we're doing this research project; understanding what is behind FIRE, now that we know FIRE exists, we have a description, and we know how prevalent it is. We need to look at the patient and look for contractions of the esophagus upon exposure to the food with manometry.   [23:18] Manometry is a tube with pressure sensors used for measuring esophageal pressure and the strength of contractions. Patients with EoE have various abnormalities in their esophageal contractions. To study FIRE, with the manometry tube in place, the patient will eat the trigger food or drink to see if there are heightened contractions.   [25:24] Manometry is not an easy test. It is done when necessary to understand esophageal motility and function. It's not easy to recruit for these tests and there are not many candidates as the symptoms go away quickly with treatment. The technicians are skilled in doing the testing. It's done routinely and safely.   [26:47] Dietary, pharmacological, steroidal, and biological treatments can be effective in treating EoE symptoms. When EoE symptoms stop, FIRE typically stops. There has not been a study to document this, but it has been observed clinically. After a patient has been treated and then is tested for esophageal motility, FIRE does not typically recur.   [28:05] Dr. Gonsalves shares her suspicion that there is something related to esophageal inflammation that triggers this type of response and a hypercontractile state in that setting. Ryan reminds listeners that this podcast is not medical advice; always consult with your physician before making any changes or trying new treatment options.   [29:40] When a provider talks to a patient, they might ask about dysphagia if they are making modifications for swallowing, and how they swallow something dry or dense. Can they perceive it going slowly down their esophagus? Are they taking in lots of liquid to help this food pass? Are they chewing excessively? Are they avoiding foods or pills?   [30:40] These questions help providers understand if there is disease activity and if they are not symptomatic because of avoiding these types of foods. Those are EoE questions.   [30:52] Asking about FIRE symptoms or oral pollen allergy symptoms, the provider will go down a list of allergic history questions about allergic rhinitis, asthma, eczema, and anaphylactic symptoms. Also, mouth itching, lip-tingling, or throat itching when they eat certain foods.   [31:20] After they eat these foods, do they ever experience an immediate sensation of narrowing or tightening or spasm in the esophagus, or burning pain that happens secondary to the dysphagia? The important thing is to separate the transit dysphagia of things moving slower down the esophagus from this perception of squeezing pain.   [32:18] Holly thanks Dr. Gonsalves for sharing her expertise to help others.   [32:37] Dr. Gonsalves's last word is that this condition exists. Providers, ask your patients about them. It was remarkable to Dr. Gonsalves how profound the symptoms were that patients described to the point where they avoided these foods and were scared of these foods.   [32:56] Interestingly, FIRE is very different from EoE symptoms. It does exist. Ask about it! That will help tease out the reactions that are occurring. Especially, understand that when going on a food elimination diet, these are separate from the EoE triggers.   [33:18] If you identify these symptoms, or oral pollen symptoms, or coexisting atopic conditions, partner with an allergist so that we understand the mechanisms behind this and make sure that nobody is at risk for anaphylaxis from these types of things.   [33:49] Dr. Gonsalves is pleased to partner with TIGERS and to be on a site for the CEGIR Group. Dr. Gonsalves heads up the development of the Non-EoE Consensus Guidelines, to understand what goes into a diagnosis of Non-EoE EGID and what that entails. She continues to research dietary therapy and making it better for patients.   [34:31] She works to understand different metrics to measure activity in the esophagus, histologically as well as motility-based, and the genetic changes that occur with different treatments, and doing all this, partnered with an amazing group of collaborators through the CEGIR Consortium and others to improve patients' quality of life.   [35:01] Dr. Gonsalves feels lucky that 20-something years ago, she bumped into the leaders of APFED and other patient advocacy groups and shared their experience with Northwestern. She is grateful for the privilege of working with all the wonderful physicians and patients who help us learn about these conditions.   [35:46] To learn more about Dr. Gonsalves's research, please check out the links in the show notes. To learn more about eosinophilic gastrointestinal disorders, visit apfed.org/egids. If you're looking for a specialist who treats eosinophilic disorders, use APFED's specialist finder at apfed.org/specialist. [36:10] To connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [36:21] Ryan thanks Dr. Nirmala Gonsalves for joining us today. Holly thanks APFED's Education Partners, AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Sanofi, and Regeneron, linked below, for supporting this episode.   Mentioned in This Episode: Nirmala Gonsalves, MD Northwestern Medicine Feinberg School of Medicine Ikuo Hirano, MD Publication discussed: Food-induced immediate response of the esophagus — A newly identified syndrome in patients with eosinophilic esophagitisAmerican Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/egids apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Sanofi, and Regeneron.   Tweetables:   “Working in the EGID space for the last 20 years; it's been incredibly rewarding. I've been lucky enough to be invited to be a part of The International Gastrointestinal Eosinophil Researchers (TIGERS).” — Nirmala Gonsalves, M.D.   “Our patients will describe it; it's a profound spasm-type squeezing in their chest that will occur when FIRE happens.” — Nirmala Gonsalves, M.D.   “There's no clear test yet for FIRE, which is why we're doing this research project; really understanding what is behind FIRE, now that we know FIRE exists, we have a description of it and we know how prevalent it is.” — Nirmala Gonsalves, M.D.   Bio: Dr. Gonsalves is a Professor of Medicine in the Division of Gastroenterology & Hepatology at Northwestern University Feinberg School of Medicine and Co-Director of the Northwestern Eosinophilic Gastrointestinal Disorders Program. She completed her undergraduate training at the University of Notre Dame, medical school at Robert Wood Johnson Medical School in New Jersey, and her internship, residency, and fellowship at Northwestern, where she has stayed on as an attending physician since 2005. In this role, she has co-authored more than 60 manuscripts and presented at more than 40 national or international meetings that focus on eosinophilic gastrointestinal diseases (EGIDs). Her research and clinical career is dedicated to improving the care of patients with these rare disorders. Her extensive clinical experiences with EGIDs have shaped the overarching research goals that include identifying novel treatments and determining the best methods to measure disease activity. She is a site investigator for the NIH-funded U54 Grant Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR, PI-Rothenberg) and Core Lead for the Northwestern Biorepository for an NIH sponsored PPG Grant on Esophageal Biomechanics (PI-Pandolfino).

Dr. Pooja Singhal, a Gastroenterologist with Oklahoma Gastro Health and Wellness, returns to the show to share her expertise on Eosinophilic Esophagitis (EoE). Specifically, Dr. Singhal answers questions about the role Non-GI Advanced Practice Practitioners play in keeping EoE patients on track with their treatment and when a patient should be referred to a gastroenterologist. She highlights what makes EoE a progressive condition and why early diagnosis, treatment and ongoing management is vital. This episode is brought to you by Sanofi Regeneron.

What happens when your patient with Eosinophilic Esophagitis (EoE) becomes pregnant? Will pregnancy trigger symptoms? Will EoE affect your pregnant patient's ability to get proper nutrition? Can patients continue using medications prescribed for EoE? We welcome back Dr. Claire Beveridge, a Gastroenterologist from The Cleveland Clinic, to answer these questions and more so Primary Care and OB-GYN providers are armed with the information they need to better support their patients. Patients will also find this episode helpful if they have questions related to EoE and pregnancy. This episode is brought to you with support from Sanofi Regeneron. 

Pediatric Gastroenterologist Dr. Sophia Patel of the Cleveland Clinic explains the presentation of Eosinophilic Esophagitis (EoE) in children and what parents and caregivers should know about treatment options that are available for children. Dr. Patel also explains the progressive nature of EoE and why treatment adherence is key to successful management of EoE. She also shares tips to help older adolescents or young adults maintain their treatment plans. This episode is brought to you by Sanofi Regeneron.   

In this episode, hosts Drs. Peter Lu and Jennifer Lee talk to Dr. Michael Wilsey about the evaluation and management of esophageal strictures in children, including congenital strictures and those arising from eosinophilic esophagitis and caustic ingestions. Dr. Wilsey is an advanced endoscopist at Johns Hopkins All Children's Hospital in St. Petersburg, FL and is a Professor at the University of South Florida.Learning Objectives:Review the presentation, evaluation, and management of congenital esophageal strictures.Understand the diagnostic tools used in the evaluation of an esophageal stricture, including the utility of functional luminal imaging probe (FLIP) testing.Understand the treatment options used for esophageal strictures, including the different types of dilation and the role of steroid injections and stenting.Links:Laughrey M, Kidder M, Rivera D, Wilsey M, Karjoo S. Development of an esophageal stricture following paradichlorobenzene mothball ingestion. SAGE Open Med Case Rep. 2020 Nov 13;8:2050313X20974210. PMID: 33240502 Support the showThis episode is eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Description: Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Holly Knotowicz, a speech-language pathologist living with EoE, who serves on APFED's Health Sciences Advisory Council, speak with Jacqueline Gaulin, the Founder of Gastro Girl, a source of information for people living with various gastrointestinal disorders. In this episode, Ryan and Holly interview Jacqueline Gaulin about her career, how she started Gastro Girl, its podcast, and the partnership between Gastro Girl, the American College of Gastroenterology, and GI on Demand.   Listen in for more information about this empowering resource for GI patients and their families. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:51] Ryan Piansky and co-host Holly Knotowicz welcome Jacqueline Gaulin, Founder of Gastro Girl, a patient-centered company that focuses on empowering individuals living with digestive health conditions through evidence-based information, resources, and access to GI experts to help people make informed healthcare decisions.   [1:42] Holly thanks Jqcqueline for having APFED's Executive Director, Mary Jo Strobel, as a guest on the Gastro Girl Podcast last fall. There is a link in the show notes.   [2:07] Jacqueline started Gastro Girl as a blog, in 2007/2008 while working for a startup, trying to do great things for healthcare. She was charged with the Digestive Health channel. They needed content on living with disease and empowering patients. She created a persona, Gastro Girl, and started a blog around her.   [2:41] Gastro Girl became a popular part of the site. The company was bought but Jacqueline retained the URL, Gastro Girl, and the persona. She engaged on Twitter and then got a job at the American College of Gastroenterology (ACG) where she dug into GI and learned the pain points from both the provider and patient sides.   [3:09] Jacqueline saw that patients didn't have the resources, access, and champions they needed so she created a company out of Gastro Girl to meet their needs. In 2019, Gastro Girl partnered with ACG to create a provider-focused platform, GI On Demand, that provides ACG members and their patients access to multi-disciplinary GI expertise.   [4:02] Ryan tells about his experiences with APFED as a person living with Eosinophilic Esophagitis and Eosinophilic Asthma. His family is passionate about the patient experience for people with eosinophilic disorders. Ryan sees that Jacqueline is also passionate about empowering patients.   [4:39] Jacqueline loves that patients and their loved ones are involved in advocacy. There is no better voice than those who walk on that health path. Jacqueline, as a child, saw her grandmother needing laxatives to feel better. Jacqueline didn't understand. Then Jacqueline got a dog with digestive problems that needed veterinary help.   [5:51] Jacqueline was fascinated by the whole connection between the digestive system and our overall health. When she started Gastro Girl she was going through a lot of trauma and lost a lot of weight. She was diagnosed with irritable bowel syndrome (IBS).   [6:48] Gastro Girl brings together resources and information that run the gamut of digestive-health-related topics. It has resources and partners, like APFED, that cover all the areas of GI and bring the pieces together to help patients find the information they need, when and how they need it.   [7:21] Holly tells how she searched symptoms online, was able to find Gastro Girl, and did a deep dive to navigate many areas. Holly also tells how she saw herself in patients' symptoms while she was helping in an EoE clinic before she was diagnosed with it.   [8:38] Gastro Girl has baseline content on what eosinophilic gastrointestinal disorders are and how they are diagnosed. Then it points to expert partners like APFED to speak to eosinophilic disorder topics and support in-depth. Gastro Girl focuses on symptoms and identifying diseases earlier to get into care quicker. [9:25] The Gastro Girl podcast and YouTube channel have episodes on EoE. The comments that come in on the videos, like “EOE 101,” Jacqueline says are mind blowing. People say the videos help them identify what possibly could be going on and get them to seek care without alarming them.   [10:34] Gastro Girl offers evidence-based information and resources so that people know they can come to the site and find sites like APFED and the ACG that are trusted and credible, that will not send them down a rabbit hole and confuse them.   [12:07] A colleague of Jacqueline's friend emailed Jacqueline with her young son's symptoms. Jacqueline isn't a doctor and can't diagnose but the symptoms sounded like EoE. She recommended that the mother ask her son's doctor if he could be tested. Two months later she heard he had eosinophilic asthma and EoE.   [13:21] Jacqueline says the biggest message we could get out there is for patients to pay attention to credible resources. She cautions patients to be mindful and use discretion when going to the sites for their health information. Dr. Google is not great. Holly directs patients toward specific videos or episodes that offer the best information.   [14:41] There are some times when Jacqueline does not approve a comment to a podcast or video if she is concerned the comment will do more damage than good. She urges listeners and viewers to exercise caution on what comments they listen to.   [16:22] Jacqueline has interviewed many patients, caregivers, and providers in the GI space. She says patients want to be heard and feel that they are being listened to and that they're getting access to the right information so they can feel better. That can mean different things to different patients in their quality of life.   [17:47] Gastro Girl is about putting the patient at the center. Being patient-centric is seeing the patient's view first. Gastro Girl supports patients having collaborative care and shared decision-making, giving information so they are more educated and informed as they ask questions and collaborate on decisions with their providers.   [19:25] Thinking critically and asking the right questions makes you an active participant in your healthcare journey, and hopefully, gets you to a better result.   [20:26] Jacqueline learns every day from her podcast guests. She has learned that healthcare providers, gastroenterologists, dieticians, and psychologists care about their patients. They want patients to get better. Their passion and caring are overwhelming.   [21:20] Jacqueline has learned that patients are resilient and committed, not only to finding better ways to have a better quality of life but also to advocacy efforts, helping, and lifting their fellow patients. Jacqueline says together we are much stronger than to be isolated by ourselves, dealing with big healthcare issues.   [22:55] Many doctors are involved in research, speaking, webinars, and educating fellow providers and patients. It's mind blowing to Jacqueline!   [23:16] Running Gastro Girl and GI on Demand during COVID-19 was hard and stressful for Jacqueline. She was inactive and gained weight. She worried about taking care of others, but not herself. She is back on track, exercising and losing weight.   [26:08] Jacqueline says we have to be kind to ourselves; we have to have compassion and grace towards ourselves. We're very kind and compassionate to others and give them grace. Make sure you extend grace to yourself.   [26:27] Jacqueline cites Tara Cousineau, author of The Kindness Cure. Positive reinforcement is better than beating yourself up. When you feel good, you're going to do the good things next time.   [27:46] Jacqueline tells about GI on Demand. It's provider-focused with multiple disciplines available for healthcare providers. Providers and patients can search for dieticians, GI psychologists, and genetic testing and counseling. This helps GI providers and their practices to help their patients better.   [31:24] Jacqueline plans for Gastro Girl to continue to do great work for patients. She is working on an educational bus tour, “Gastro Girl to the Rescue Bus Tour!” with partners such as APFED, to bring information to individuals at home. Patients can be guided to resources, like getting a proper diagnosis or finding a provider. It's a lot of logistics!   [32:56] To check out Gastro Girl's website, visit GastroGirl.com. To learn more about eosinophilic disorders check out the resources there and also visit APFED.org. If you're looking for a specialist who treats eosinophilic disorders, you can use APFED's Specialist Finder at APFED.org/Specialist.   [33:21] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/Connections.   [33:30] Ryan and Holly thank Jacqueline Gaulin again for joining them. Ryan would be happy to go on the Gastro Girl podcast any time to talk more! Holly thanks APFED's education partners, linked below, for supporting this episode.   Mentioned in This Episode: Jacqueline A. Gaulin Gastro GirlWhere Can I Find Resources for Eosinophilic Disorders? Special Guest Mary Jo Strobel GI on Demand Gastro Girl Channel on YouTube The Kindness Cure: How the Science of Compassion Can Heal Your Heart and Your World, by Tara Cousineau American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, Sanofi, and Regeneron.   Tweetables:   “I love when patients get involved in advocacy because there's no better voice for the patient than those who walk in that path, whatever their health condition or journey is, or even if they have a loved one.” — Jacqueline Gaulin   “What Gastro Girl really offers is evidence-based information and resources so that people know that they can come to our site and find sites like APFED and the ACG that are trusted and credible.” — Jacqueline Gaulin “The biggest message we could get out there is for patients to pay attention to the credible resources. I just caution patients to be mindful and use discretion when going to the sites for your health information.” — Jacqueline Gaulin   “To think critically and to ask the right questions will get you, hopefully, a better result in your healthcare journey because you're not just a passive participant, you're actively playing an important role in your healthcare with your provider.” — Jacqueline Gaulin   About Jacqueline Gaulin An early champion of a patient-centric, collaborative, and multidisciplinary approach to gastrointestinal health, I worked for several early-stage health-related start-ups, including Revolution Health. During my time with the American College of Gastroenterology (ACG), I led the ACG into the digital age by creating and executing strategic communications plans and patient education campaigns around a variety of digestive health topics and related research, including IBS, IBD, Liver disease and colorectal cancer awareness.   After six years with the ACG, my passion for empowering patients inspired me to evolve my popular blog, Gastro Girl, into a digital health company in 2015, Gastro Girl, Inc., to provide patients with access to the GI expertise and evidence-based information and resources they need to follow their doctor's treatment plan and make informed health care decisions with their care team for better health outcomes.  

Eosinophilic Esophagitis (EoE) is increasingly recognized as a major cause of swallowing difficulties in children and adults. It affects about one in 2,000 people. But the differences in EoE presentation and outcomes by ethnicity and race remain understudied. Dr Evan Dellon from the University of North Carolina School of Medicine at Chapel Hill is here to explain EoE and discuss the recent findings of a study he co-authored, “Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis.”  We focus on what patients need to know about the main findings, as well as tips for patients to begin discussing their symptoms and treatment options with their provider. This episode is brought to you by Sanofi Regeneron.   

On this episode of Food Allergy Talk, I welcome Jennifer Togal. Jennifer is mom to Adina, the spark behind The ADINA Act, which will require all OTC and RX medications to be labeled with any applicable food allergens and/or gluten ingredients and related information.Jennifer carries an EpiPen herself and Adina has Celiac disease, a dairy allergy, and they both have EoE. They live in the Minneapolis, Minnesota suburbs. Need to freshen up on your knowledge of legislation? Check out this educational video referenced in this podcast episode:Schoolhouse Rock "How a Bill Becomes a Law".Take action and help support The ADINA Act. Links referenced in this podcast:House Bill HR 4263Senate Bill S. 2079Linktreehttps://linktr.ee/theadinaact The Linktree has links to a 1-pager fact sheet (first link on page), press releases as well as news stories about the ADINA ActFARE link to auto-send letters to Rep's and Senatorshttps://foodallergy.quorum.us/campaign/48768/Instagram@the_Adina_act_effortFB Grouphttps://www.facebook.com/groups/3347959928865461/Locate your US Representativehttps://www.house.gov/representatives/find-your-representative#:~:text=If%20you%20know%20who%20your,the%20U.S.%20House%20switchboard%20operator.Locate your US Senatorhttps://www.senate.gov/senators/senators-contact.htmJoin My Private Facebook Group to connect, support and share: https://www.facebook.com/groups/FoodAllergyPI/Read My Articles on WebMD: https://blogs.webmd.com/food-allergies/lisa-horneThe Everything Nut Allergy Cookbook: https://www.simonandschuster.com/authors/Lisa-Horne/190009636The Food Allergy Talk Podcast: https://foodallergypi.com/the-food-allergy-talk-podcast/Food Allergy P.I. Blog: https://foodallergypi.comX: @foodallergypi & @fatalkpodcastInstagram: https://www.instagram.com/foodallergypi/ and https://www.instagram.com/foodallergytalk/ TikTok: https://www.tiktok.com/@foodallergypiEmail: foodallergypi@gmail.com

#414: It's not uncommon for infants or toddlers to refuse food. Food refusal can be due to illness, tiredness, your baby's temperament on that day…but, there is a disease that results in food refusal called Eosinophilic esophagitis or EOE. EOE is a chronic, allergic inflammatory disease of the esophagus that causes damage that makes it difficult and uncomfortable for the baby or toddler to eat which in turn results in poor growth, chronic pain and/or difficulty swallowing. The symptoms of EOE are sometimes confused with reflux and in this episode Dr. Antonella Cianferoni, MD, PhD explains what EOE is…why it sometimes gets confused with REFLUX, how it's treated as an allergic disease….and I think you'll be surprised because the treatment and certainly the diagnosis is quite different than the other allergic diseases we've covered here on the podcast. CHOP's Center for Eosinophilic Disorders: https://www.chop.edu/centers-programs/center-pediatric-eosinophilic-disorders  American Partnership for Eosinophilic Disorders (APFED): https://apfed.org/about-ead/egids/eoe/ Shownotes for this episode are here: https://blwpodcast.com/414 

#414: It's not uncommon for infants or toddlers to refuse food. Food refusal can be due to illness, tiredness, your baby's temperament on that day…but, there is a disease that results in food refusal called Eosinophilic esophagitis or EOE. EOE is a chronic, allergic inflammatory disease of the esophagus that causes damage that makes it difficult and uncomfortable for the baby or toddler to eat which in turn results in poor growth, chronic pain and/or difficulty swallowing. The symptoms of EOE are sometimes confused with reflux and in this episode Dr. Antonella Cianferoni, MD, PhD explains what EOE is…why it sometimes gets confused with REFLUX, how it's treated as an allergic disease….and I think you'll be surprised because the treatment and certainly the diagnosis is quite different than the other allergic diseases we've covered here on the podcast. CHOP's Center for Eosinophilic Disorders: https://www.chop.edu/centers-programs/center-pediatric-eosinophilic-disorders  American Partnership for Eosinophilic Disorders (APFED): https://apfed.org/about-ead/egids/eoe/ Shownotes for this episode are here: https://blwpodcast.com/414 

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/GXN865. CME/MOC/AAPA credit will be available until February 20, 2025.Timing Matters: Expert Insights on When to Use Targeted Biologic Therapy for Patients With Eosinophilic Esophagitis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc. and Sanofi.Disclosure PolicyAll relevant conflicts of interest have been mitigated prior to the commencement of the activity.Faculty/Planner DisclosuresChair/PlannerNirmala Gonsalves, MD, AGAF, FACG, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for Allakos Inc.; AstraZeneca; Bristol Myers Squibb; Regeneron Pharmaceuticals Inc.; and Sanofi.Speaker for Regeneron Pharmaceuticals Inc. and Sanofi.Planning Committee and Reviewer DisclosuresPlanners, independent reviewers, and staff of PVI, PeerView Institute for Medical Education, do not have any relevant financial relationships related to this CE activity unless listed below.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/GXN865. CME/MOC/AAPA credit will be available until February 20, 2025.Timing Matters: Expert Insights on When to Use Targeted Biologic Therapy for Patients With Eosinophilic Esophagitis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc. and Sanofi.Disclosure PolicyAll relevant conflicts of interest have been mitigated prior to the commencement of the activity.Faculty/Planner DisclosuresChair/PlannerNirmala Gonsalves, MD, AGAF, FACG, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for Allakos Inc.; AstraZeneca; Bristol Myers Squibb; Regeneron Pharmaceuticals Inc.; and Sanofi.Speaker for Regeneron Pharmaceuticals Inc. and Sanofi.Planning Committee and Reviewer DisclosuresPlanners, independent reviewers, and staff of PVI, PeerView Institute for Medical Education, do not have any relevant financial relationships related to this CE activity unless listed below.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/DXM865. CME/MOC/AAPA credit will be available until February 12, 2025.Targeting a Brighter Future for Pediatric Patients With Eosinophilic Esophagitis: Ensuring Prompt Diagnosis and Exploring the Role of Biologic Treatment In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Campaign Urging Research for Eosinophilic Disease. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc and Sanofi.Disclosure PolicyAll relevant conflicts of interest have been mitigated prior to the commencement of the activity.Faculty/Planner DisclosuresChair/PlannerJoshua B. Wechsler, MD, MSci, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for AstraZeneca; Bristol Myers Squibb; Ellodi Pharmaceuticals; Regeneron Pharmaceuticals, Inc; and Sanofi.Grant/Research Support from Regeneron Pharmaceuticals, Inc and Sanofi.Speaker for Regeneron Pharmaceuticals, Inc and Sanofi.Patient Advocate/PlannerHolly Roland has no financial interests/relationships or affiliations in relation to this activity.Planning Committee and Reviewer DisclosuresPlanners, independent reviewers, and staff of PVI, PeerView Institute for Medical Education, do not have any relevant financial relationships related to this CE activity unless listed below.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/DXM865. CME/MOC/AAPA credit will be available until February 12, 2025.Targeting a Brighter Future for Pediatric Patients With Eosinophilic Esophagitis: Ensuring Prompt Diagnosis and Exploring the Role of Biologic Treatment In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Campaign Urging Research for Eosinophilic Disease. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc and Sanofi.Disclosure PolicyAll relevant conflicts of interest have been mitigated prior to the commencement of the activity.Faculty/Planner DisclosuresChair/PlannerJoshua B. Wechsler, MD, MSci, has a financial interest/relationship or affiliation in the form of:Consultant and/or Advisor for AstraZeneca; Bristol Myers Squibb; Ellodi Pharmaceuticals; Regeneron Pharmaceuticals, Inc; and Sanofi.Grant/Research Support from Regeneron Pharmaceuticals, Inc and Sanofi.Speaker for Regeneron Pharmaceuticals, Inc and Sanofi.Patient Advocate/PlannerHolly Roland has no financial interests/relationships or affiliations in relation to this activity.Planning Committee and Reviewer DisclosuresPlanners, independent reviewers, and staff of PVI, PeerView Institute for Medical Education, do not have any relevant financial relationships related to this CE activity unless listed below.

FDA approves first treatment for severe frostbite; Eohilia gains approval to treat eosinophilic esophagitis; MDMA accepted for Priority Review for PTSD; novel subcutaneous to be reviewed for prurigo nodularis, atopic dermatitis; OTC pulse oximeter device is cleared.

Eosinophilic esophagitis --- Send in a voice message: https://podcasters.spotify.com/pod/show/tyler-paul-wolfe/message Support this podcast: https://podcasters.spotify.com/pod/show/tyler-paul-wolfe/support

This week's podcast, we will discuss eosinophilic esophagitis (EoE). Which is a chronic inflammatory condition of the esophagus and can be characterized by an accumulation of eosinophils, a white blood cell, in the esophageal lining. Join Dr. Niket Sonapl as he discusses the symptoms your patient might present with are difficulty swallowing, chest pain, heartburn and nausea. EoE is diagnosed through a combination of medical history, physical exam and endoscopy. The different treatments can be offered are dietary elimination and medications such as corticosteroids. September 18, 2023 — Do you work in primary care medicine? Primary Care Medicine Essentials is our brand new program specifically designed for primary care providers to increase their core medical knowledge & improve patient flow optimization. Learn more here: Primary Care Essentials —