Podcasts about Eosinophilic esophagitis

living overcome patients treatments navigate symptoms triggers tackle sanofi regeneron eoe eosinophilic esophagitis

Play Episode Listen Later Jul 31, 2025 20:15

Living with Eosinophilic Esophagitis (EoE)—a chronic, often misunderstood condition—can make eating and even swallowing a daily challenge. In this inspiring episode, patient advocate Matt shares his personal journey navigating life with EoE. From the struggle of getting an accurate diagnosis, to identifying and managing daily food triggers, to finding a treatment plan that works, Matt offers an honest look at the physical, emotional, and social realities of living with this condition. His story sheds light on the resilience, trial-and-error, and determination it takes to keep moving forward. In this episode, we discuss how to: Overcome the challenges of getting a proper EoE diagnosis Tackle daily triggers and make smart dietary changes Fine-tune a treatment plan to get real results Navigate the emotional and social toll of a chronic swallowing condition Whether you're living with EoE, supporting someone who is, or just want to understand this condition better, you'll gain valuable insights, practical tips, and a sense of hope from Matt's journey. Resources & Support: Learn more about EoE and find trusted resources: gastrogirl.com This episode was made possible with support from Sanofi and Regeneron.

Bowel Sounds Summer School - Eosinophilic Esophagitis

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Play Episode Listen Later Jul 14, 2025 34:08

In this episode of Bowel Sounds Summer School, hosts Drs. Jennifer Lee and Peter Lu have taken highlights from past episodes on eosinophilic esophagitis (EoE) and put them into a special episode jam-packed with clinical pearls. Former expert guests Dr. Glenn Furuta, Dr. Amanda Muir, Dr. Rachel Chevalier, and Dr. Mike Wilsey explain how to diagnose, treat, and monitor patients with EoE.Our Bowel Sounds Summer School series will include 4 episodes each summer on big topics in our field, artisanally crafted for the ears of listeners of all stages from the young student to the seasoned attending.Learning ObjectivesReview clinical presentation and diagnostic criteria for eosinophilic esophagitis (EoE)Review dietary and medication treatment options for EoE Review methods of monitoring treatment response in EoEFeatured EpisodesGlenn Furuta - Eosinophilic EsophagitisAmanda Muir - Navigating the Challenges of Eosinophilic Esophagitis ManagementRachel Chevalier - Update on Topical Steroids for EoEMike Wilsey - Esophageal Strictures in ChildrenSupport 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.

Evan S. Dellon, MD, MPH - Stepping Up the Management of Eosinophilic Esophagitis: Answering Key Questions on Diagnosis and Use of Pharmacotherapies

CME in Minutes: Education in Primary Care

Play Episode Listen Later Jul 4, 2025 19:42

Please visit answersincme.com/XFS860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in esophageal disease addresses common queries related to the diagnosis and management of eosinophilic esophagitis (EoE). Upon completion of this activity, participants should be better able to: Identify diagnostic criteria and practical strategies to facilitate the timely diagnosis of EoE; Review the clinical impact of pharmacotherapies in patients with EoE; and Discuss personalized strategies to optimize patient outcomes with pharmacotherapies in EoE.

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Bone Mineral Density in Pediatric Eosinophilic Esophagitis

PeerView Family Medicine & General Practice CME/CNE/CPE Video Podcast

Play Episode Listen Later Jun 24, 2025 33:16

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 Anna Henderson, MD, a pediatric gastroenterologist at Northern Light Health in Maine, about bone mineral density in EoE patients. They discuss a paper she co-authored on the subject. 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, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz. [1:17] Holly introduces today's topic, eosinophilic esophagitis (EoE), and bone density. [1:22] Holly introduces today's guest, Dr. Anna Henderson, a pediatric gastroenterologist at Northern Light Health in Maine. [1:29] During her pediatric and pediatric gastroenterology training at Cincinnati Children's Hospital, she took a special interest in eosinophilic esophagitis. In 2019, Dr. Henderson received APFED's NASPGHAN Outstanding EGID Abstract Award. [1:45] Holly, a feeding therapist in Maine, has referred many patients to Dr. Henderson and is excited to have her on the show. [2:29] Dr. Henderson is a wife and mother. She loves to swim and loves the outdoors. She practices general pediatric GI in Bangor, Maine, at a community-based academic center. [2:52] Her patient population is the northern two-thirds of Maine. Dr. Henderson feels it is rewarding to bring her expertise from Cincinnati to a community that may not otherwise have access to specialized care. [3:13] Dr. Henderson's interest in EoE grew as a GI fellow at Cincinnati Children's. Her research focused on biomarkers for disease response to dietary therapies and EoE's relationship to bone health. [3:36] As a fellow, Dr. Henderson rotated through different specialized clinics. She saw there were many unanswered questions about the disease process, areas to improve treatment options, and quality of life for the patients suffering from these diseases. [4:00] Dr. Henderson saw many patients going through endoscopies. She saw the social barriers for patients following strict diets. She saw a huge need in EoE and jumped on it. [4:20] Ryan grew up with EoE. He remembers the struggles of constant scopes, different treatment options, and dietary therapy. Many people struggled to find what was best for them before there was a good approved treatment. [4:38] As part of Ryan's journey, he learned he has osteoporosis. He was diagnosed at age 18 or 19. His DEXA scan had such a low Z-score that they thought the machine was broken. He was retested. [5:12] Dr. Henderson explains that bone mineral density is a key measure of bone health and strength. Denser bones contain more minerals and are stronger. A low bone mineral density means weaker bones. Weaker bones increase the risk of fracture. [5:36] DEXA scan stands for Dual Energy X-ray Absorptiometry scan. It's a type of X-ray that takes 10 to 30 minutes. A machine scans over their bones. Typically, we're most interested in the lumbar spine and hip bones. [5:56] The results are standardized to the patient's height and weight, with 0 being the average. A negative number means weaker bones than average for that patient's height and weight. Anything positive means stronger bones for that patient's height and weight. [6:34] A lot of things can affect a patient's bone mineral density: genetics, dietary history, calcium and Vitamin D intake, and medications, including steroid use. Prednisone is a big risk factor for bone disease. [7:07] Other risk factors are medical and auto-immune conditions, like celiac disease, and age. Any patient will have their highest bone density in their 20s to 30s. Females typically have lower bone mineral density than males. [7:26] The last factor is lifestyle. Patients who are more active and do weight-bearing exercises will have higher bone mineral density than patients who have more of a sedentary lifestyle. [7:56] Ryan was told his bone mineral density issues were probably a side-effect of the long-term steroids he was on for his EoE. Ryan is now on benralizumab for eosinophilic asthma. He is off steroids. [8:36] Dr. Henderson says the research is needed to find causes of bone mineral density loss besides glucocorticoids. [8:45] EoE patients are on swallowed steroids, fluticasone, budesonide, etc. Other patients are on steroids for asthma, eczema, and allergic rhinitis. These may be intranasal steroids or topical steroids. [9:01] Dr. Henderson says we wondered whether or not all of those steroids and those combined risks put the EoE population at risk for low bone mineral density. There's not a lot published in that area. [9:14] We know that proton pump inhibitors can increase the risk of low bone mineral density. A lot of EoE patients are on proton pump inhibitors. [9:23] That was where Dr. Henderson's interest started. She didn't have a great way to screen for bone mineral density issues or even know if it was a problem in her patients more than was expected in a typical patient population. [9:57] Holly wasn't diagnosed with EoE until she was in her late 20s. She was undiagnosed but was given prednisone for her problems. Now she wonders if she should get a DEXA scan. [10:15] Holly hopes the listeners will learn something and advocate for themselves or for their children. [10:52] If a patient is concerned about their bone mineral density, talking to your PCP is a perfect place to start. They can discuss the risk factors and order a DEXA scan and interpret it, if needed. [11:11] If osteoporosis is diagnosed, you should see an endocrinologist, specifically to discuss therapy, including medications called bisphosphonates. [11:36] From an EoE perspective, patients can talk to their gastroenterologist about what bone mineral density risk factors may be and if multiple risk factors exist. Gastroenterologists are also more than capable of ordering DEXA scans and helping their patients along that journey. [11:53] A DEXA scan is typically the way to measure bone mineral density. It's low radiation, it's easy, it's fast, and relatively inexpensive. [12:10] It's also useful in following up over time in response to different interventions, whether or not that's stopping medications or starting medications. [12:30] Dr. Henderson co-authored a paper in the Journal of Pediatric Gastroenterology and Nutrition, called “Prevalence and Predictors of Compromised Bone Mineral Density in Pediatric Eosinophilic Esophagitis.” The study looked at potential variables. [12:59] The researchers were looking at chronic systemic steroid use. They thought it was an issue in their patients, especially patients with multiple atopic diseases like asthma, eczema, and allergic rhinitis. That's where the study started. [13:22] Over the years, proton pump inhibitors have become more ubiquitous, and more research has come out. The study tried to find out if this was an issue or not. There weren't any guidelines for following these patients, as it was a retrospective study. [13:42] At the time, Dr. Henderson was at a large institution with a huge EoE population. She saw that she could do a study and gather a lot of information on a large population of patients. Studies like this are the start of figuring out the guidelines for the future. [14:34] Dr. Henderson wanted to determine whether pediatric patients with EoE had a lower-than-expected bone mineral density, compared to their peers. [14:44] Then, if there were deficits, she wanted to determine where they were more pronounced. Were they more pronounced in certain subgroups of patients with EoE? [14:59] Were they patients with an elemental diet? Patients with an elimination diet? Were they patients on steroids or PPIs? Were they patients with multiple atopic diseases? Is low bone mineral density just a manifestation of their disease processes? [15:14] Do patients with active EoE have a greater propensity to have low bone mineral density? The study was diving into see what the potential risk factors are for this patient population. [15:45] The study was a retrospective chart review. They looked at patients aged 3 to 21. You can't do a DEXA scan on a younger patient, and 21 is when people leave pediatrics. [16:03] These were all patients who had the diagnosis of EoE and were seen at Cincinnati Children's in the period between 2014 and 2017. That period enabled full ability for chart review. Then they looked at the patients who had DEXA scans. [16:20] They did a manual chart review of all of the patients and tried to tease out what the potential exposures were. They looked at demographics, age, sex, the age of the diagnosis of EoE, medications used, such as PPIs, and all different swallowed steroids. [16:44] They got as complete a dietary history as they could: whether or not patients were on an elemental diet, whether that was a full elemental diet, whether they were on a five-food, six-food, or cow's milk elimination diet. [16:58] They teased out as much as they could. One of the limitations of a retrospective chart review is that you can't get some of the details, compared to doing a prospective study. For example, they couldn't tease out the dosing or length of therapy, as they would have liked. [17:19] They classified those exposures as whether or not the patient was ever exposed to those medications, whether or not they were taking them at the time of the DEXA scan, or if they had been exposed within the year before the DEXA scan. [17:40] They also looked at whether the patients had other comorbid atopic disorders, to see if those played a role, as well. [18:03] The study found that there was a slightly lower-than-expected bone mineral density in the patients. The score was -0.55, lower than average but not diagnostic of a low bone mineral density, which would be -2 or below. [18:27] There were 23 patients with low bone mineral density scores of -2 or below. That was 8.6% of the study patients. Typically, only 2.5% of the population would have that score. It was hard to tease out the specific risk factors in a small population of 23. [18:57] They looked at what the specific risk factors were that were associated with low bone mineral density, or bone mineral density in general. [19:12] After moving from Colorado, Holly has transferred to a new care team, and doctors wanted her baseline Vitamin D and Calcium levels. No one had ever tested that on her before. Dr. Henderson says it's hard because there's nothing published on what to do. [19:58] The biggest surprise in the study was that swallowed steroids, or even combined steroid exposure, didn't have any effect on bone mineral density. That was reassuring, in light of what is known about glucocorticoid use. [20:16] The impact of PPI use was interesting. The study found that any lifetime use of PPIs did seem to decrease bone mineral density. It was difficult to tease out the dosing and the time that a patient was on PPIs. [20:34] Dr. Henderson thinks that any lifetime use of PPIs is more of a representation of their cumulative use of PPIs. At the time of the study, from 2014 to 2017, PPIs were still very much first-line therapy for EoE; 97% of the study patients had taken PPIs at some time. [21:02] There are so many more options now for therapy when a patient has a new diagnosis of EoE, especially with dupilumab now being an option. [21:11] Dr. Henderson speaks of patients who started on PPIs and have stayed on them for years. This study allows her to question whether we need to continue patients on PPIs. When do we discuss weaning patients off PPIs, if appropriate? [22:05] Ryan says these podcasts are a great opportunity for the community at large and also for the hosts. He just wrote himself a note to ask his endocrinologist about coming off PPIs. [22:43] Dr. Henderson says that glucocorticoid use is a known risk factor for low bone mineral density and osteoporosis. In the asthma population, inhaled steroids can slightly decrease someone's growth potential while the patient is taking them. [23:10] From those two facts, it was thought that swallowed steroids would have a similar effect. But since they're swallowed and not systemic, maybe things are different. [23:23] It was reassuring to Dr. Henderson that what her study found was that the swallowed steroid didn't affect bone mineral density. There was one other study that found that swallowed steroids for EoE did not affect someone's height. [23:51] Dr. Henderson clarifies that glucocorticoids include systemic steroids like prednisone and hydrocortisone. [23:57] Based on Dr. Henderson's retrospective study, fluticasone as a swallowed steroid did not affect bone mineral density. It was hard to tease out the dosing, but the cumulative use did not seem to result in a deficit for bone mineral density. [24:16] Holly shared that when she tells a family of a child she works with that the child's gastroenterologist will likely recommend steroids, she will now give them the two papers Dr. Henderson mentioned. There are different types of steroids. The average person doesn't know the difference. [25:15] Dr. Henderson thinks that for patients who have multiple risk factors for low bone mineral density, it is reasonable to have a conversation about bone health with their gastroenterologist to see whether or not a DEXA scan would be worth it. [25:56] If low bone mineral density is found, that needs to be followed up on. [26:03] There are no great guidelines, but this study is a good start on what these potential risk factors are. We need some more prospective studies to look at these risk factors in more detail than Dr. Henderson's team teased out in this retrospective study. [26:23] Dr. Henderson tells how important it is for patients to participate in prospective longitudinal studies for developing future guidelines. [26:34] Holly points out that a lot of patients are on restrictive diets. It's important to think about the whole picture if you are starting a medication or an elimination, or a restricted diet. You have to think about the impact on your body, overall. [27:11] People don't think of dietary therapy as medication, but it has risks and benefits involved, like a medication. [27:50] Dr. Henderson says, in general, lifestyle management is the best strategy for managing bone health. Stay as active as you can with weight-bearing exercises and eating a well-balanced diet. If you are on a restrictive diet, make sure it's well-balanced. [28:12] Dr. Henderson says a lot of our patients have feeding disorders, so they see feeding specialists like Holly. A balanced diet is hard when kids are very selective in their eating habits. [29:10] Dr. Henderson says calcium and Vitamin D are the first steps in how we treat patients with low bone mineral density. A patient who is struggling with osteoporosis needs to discuss it with their endocrinologist for medications beyond supplementation. [29:31] Ryan reminds listeners who are patients always to consult with their medical team. Don't go changing anything up just because of what we're talking about here. Ask your care team some good questions. [29:47] Dr. Henderson would like families to be aware, first, that some patients with EoE will have bone mineral density loss, especially if they are on PPIs and restrictive diets. They should start having those discussions with their providers. [30:04] Second, Dr. Henderson would like families to be reassured that swallowed steroids and combined steroid exposure didn't have an impact on bone mineral density. Everyone can take that away from today's chat. [30:18] Lastly, Dr. Henderson gives another plug for patient participation in prospective studies, if they're presented with the opportunity. It's super important to be able to gather more information and make guidelines better for our patients. [30:35] Holly thanks Dr. Henderson for coming on Real Talk — Eosinophilic Diseases and sharing her insights on bone mineral density, and supporting patients in Maine. [30:57] Dr. Henderson will continue to focus on the clinical side. She loves doing outreach clinics in rural Maine. It's rewarding, getting to meet all of these patients and taking care of patients who would otherwise have to travel hours to see a provider. [32:01] Ryan thinks the listeners got a lot out of this. For our listeners who would like to learn more about eosinophilic disorders, please visit APFED.org and check out the links in the show notes. [32:11] If you're looking to find specialists who treat eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist. [32:19] 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. [32:28] Ryan thanks Dr. Henderson for joining us today for this great conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, Sanofi, Regeneron, and Takeda for supporting this episode. Mentioned in This Episode: Anna Henderson, MD, a pediatric gastroenterologist at Northern Light Health in Maine Cincinnati Children's “Prevalence and Predictors of Compromised Bone Mineral Density in Pediatric Eosinophilic Esophagitis.” Journal of Pediatric Gastroenterology and Nutrition 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, Sanofi, Regeneron, and Takeda. Tweetables: “DEXA scan stands for dual-energy X-ray absorptiometry scan. It's a type of X-ray where a patient lies down for 10 to 30 minutes. A machine scans over their bones. Typically, we're most interested in the lumbar spine and hip bones.” — Anna Henderson, MD “We wondered whether or not all of those steroids and those combined risks even put our EoE population at risk for low bone mineral density. There's not a lot published in that area.” — Anna Henderson, MD “If a patient is worried [about their bone mineral density], their PCP is a perfect place to start for that. They're more than capable of discussing the risk factors specific for that patient, ordering a DEXA scan, and interpreting it if need be.” — Anna Henderson, MD “I think we need some more prospective studies to look at these risk factors in a little bit more detail than we were able to tease out in our retrospective review.” — Anna Henderson, MD “Just another plug for the participation in prospective studies, if you're presented with the opportunity. It's super important to be able to gather more information and to be able to make guidelines better for our patients about these risks.” — Anna Henderson, MD

Sophia A. Patel, MD - Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs

Play Episode Listen Later Apr 1, 2025 26:16

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/KVY865. CME/MOC/AAPA credit will be available until March 19, 2026.Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs 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.

Sophia A. Patel, MD - Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs

PeerView Clinical Pharmacology CME/CNE/CPE Audio Podcast

Play Episode Listen Later Apr 1, 2025 26:16

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/KVY865. CME/MOC/AAPA credit will be available until March 19, 2026.Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs 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.

Sophia A. Patel, MD - Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs

PeerView Family Medicine & General Practice CME/CNE/CPE Audio Podcast

Play Episode Listen Later Apr 1, 2025 26:16

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/KVY865. CME/MOC/AAPA credit will be available until March 19, 2026.Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs 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.

Sophia A. Patel, MD - Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs

PeerView Clinical Pharmacology CME/CNE/CPE Video

Play Episode Listen Later Apr 1, 2025 26:16

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/KVY865. CME/MOC/AAPA credit will be available until March 19, 2026.Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs 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.

Sophia A. Patel, MD - Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs

PeerView Gastroenterology CME/CNE/CPE Audio Podcast

Play Episode Listen Later Apr 1, 2025 26:16

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/KVY865. CME/MOC/AAPA credit will be available until March 19, 2026.Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs 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.

Sophia A. Patel, MD - Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs

PeerView Gastroenterology CME/CNE/CPE Video Podcast

Play Episode Listen Later Apr 1, 2025 26:16

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/KVY865. CME/MOC/AAPA credit will be available until March 19, 2026.Mastering the Art of Referring Pediatric Patients With Eosinophilic Esophagitis to Specialty Care for Timely Treatment: Spotting the Signs 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.

Full Circle: An Immunologist's Unexpected EoE Journey

Play Episode Listen Later Mar 25, 2025 39:21

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

Glenn Furuta and Noam Zevit - Caring for Children With Non-EoE Eosinophilic GI Disorders

children caring credit disorders explain blue sky gi drs pediatrics cme noam gastroenterology eoe showthis eosinophilic esophagitis eosinophilic pediatric gastroenterology furuta jenn lee

Play Episode Listen Later Mar 24, 2025 56:25

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.

Episode #73: Insights into the Rising Prevalence of Eosinophilic Esophagitis|Lisa Mathew & Vijay Yajnik | Takeda

Gastro Broadcast

Play Episode Listen Later Mar 13, 2025 21:20

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

rising medical approximately prevalence gastroenterology takeda eoe eosinophilic esophagitis castle biosciences

Eosinophilic Esophagitis (EoE) Diagnosis & Treatment: What's New in the ACG Guidelines

children management hospitals treatments diagnosis guidelines american colleges sanofi gastroenterology gastroenterologist northwestern university feinberg school eoe eosinophilic esophagitis pediatric gastroenterologist

Play Episode Listen Later Mar 11, 2025 44:02

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.

The Intersection of Food Allergy and Eosinophilic Esophagitis

The Veterans Disability Nexus

Play Episode Listen Later Feb 27, 2025 50:03

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

Eosinophilic Esophagitis and Gulf War Veterans | All You Need To Know

Play Episode Listen Later Feb 6, 2025 7:35

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.

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Kristle L. Lynch, MD - A Collaborative Approach to Identifying Eosinophilic Esophagitis in the ED: Emergency Presentation, Timely Diagnosis

PeerView Gastroenterology CME/CNE/CPE Audio Podcast

Play Episode Listen Later Feb 6, 2025 40:45

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.

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Kristle L. Lynch, MD - A Collaborative Approach to Identifying Eosinophilic Esophagitis in the ED: Emergency Presentation, Timely Diagnosis

PeerView Gastroenterology CME/CNE/CPE Video Podcast

Play Episode Listen Later Feb 6, 2025 40:45

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.

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Rachel Chevalier - What You Need to Know About Topical Steroids for Eosinophilic Esophagitis

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Play Episode Listen Later Jan 27, 2025 54:42

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.

#56 - Eosinophilic Esophagitis - Part 2

The Turd Nerds

Play Episode Listen Later Jan 7, 2025 24:46

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.

ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis

American Journal of Gastroenterology - Author Podcasts

Play Episode Listen Later Jan 2, 2025 19:16

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#55 - Eosinophilic Esophagitis - Part 1

The Turd Nerds

Play Episode Listen Later Dec 24, 2024 36:53

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.

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Q&A with Leyla, Part 1: Copper Supplements

Intelligent Medicine

Play Episode Listen Later Dec 12, 2024 28:44

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?

Long Term Efficacy and Safety of Dupilumab for Eosinophilic Esophagitis

Evidence-Based GI: An ACG Publication and Podcast

Play Episode Listen Later Dec 11, 2024 12:27

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Prof. Arjan Bredenoord / Kathryn A. Peterson, MD, MSCI - Improving Care for Pediatric and Adult Patients With Eosinophilic Esophagitis: Expert Insights on the Latest Evidence for Targeted Therapy

PeerView Clinical Pharmacology CME/CNE/CPE Audio Podcast

Play Episode Listen Later Dec 9, 2024 28:20

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.

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Prof. Arjan Bredenoord / Kathryn A. Peterson, MD, MSCI - Improving Care for Pediatric and Adult Patients With Eosinophilic Esophagitis: Expert Insights on the Latest Evidence for Targeted Therapy

PeerView Clinical Pharmacology CME/CNE/CPE Video

Play Episode Listen Later Dec 9, 2024 28:20

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.

patients prof peterson disclosure pediatric medical education expert insights sanofi msci arjan targeted therapy accreditation council improving care eosinophilic esophagitis regeneron pharmaceuticals adult patients pvi continuing medical education accme pharmacy education acpe practice aids peerview institute

Eosinophilic Esophagitis (EoE) FAQs Part 3: What Role Does Endoscopy Play in Diagnosing and Managing EoE?

managing faqs diagnosing endoscopy eoe eosinophilic esophagitis

Play Episode Listen Later Dec 6, 2024 16:03

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.

Eosinophilic Esophagitis (EoE) FAQs Part 2: What Are PPIs, Steroids and Biologics?

steroids faqs biologics ppis eoe eosinophilic esophagitis

Play Episode Listen Later Dec 5, 2024 14:50

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.

Eosinophilic Esophagitis (EoE) FAQs Part 1: Is EoE a Food Allergy?

wellness faq faqs allergy food allergies eoe eosinophilic esophagitis

Play Episode Listen Later Dec 3, 2024 13:10

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.

Mirna Chehade, MD, MPH, AGAF, FAAAAI / Evan S. Dellon, MD, MPH - Early Diagnosis and Evolving Management of Eosinophilic Esophagitis in the Era of Targeted Therapy

PeerView Family Medicine & General Practice CME/CNE/CPE Video Podcast

Play Episode Listen Later Nov 22, 2024 55:53

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.

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Mirna Chehade, MD, MPH, AGAF, FAAAAI / Evan S. Dellon, MD, MPH - Early Diagnosis and Evolving Management of Eosinophilic Esophagitis in the Era of Targeted Therapy

PeerView Family Medicine & General Practice CME/CNE/CPE Audio Podcast

Play Episode Listen Later Nov 22, 2024 55:53

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.

management patients era evolving disclosure medical education sanofi md mph targeted therapy early diagnosis accreditation council eosinophilic esophagitis regeneron pharmaceuticals pvi agaf continuing medical education accme pharmacy education acpe practice aids peerview institute cme moc aapa ipce

Eosinophilic Esophagitis and Gulf War Veterans

The Veterans Disability Nexus

Play Episode Listen Later Nov 13, 2024 7:35

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.

Evan S. Dellon, MD, MPH - In Case of Emergency: Ensuring Timely Recognition and Intervention in Patients With Eosinophilic Esophagitis

CME in Minutes: Education in Primary Care

Play Episode Listen Later Nov 6, 2024 13:02

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.

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Navigating Eosinophilic Esophagitis in College with Kate Goncalves

MedEvidence! Truth Behind the Data

Play Episode Listen Later Oct 24, 2024 34:24

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

Play Episode Listen Later Oct 2, 2024 32:52 Transcription Available

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!

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Eosinophilic Esophagitis (EoE) 101: 2024 Update

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Play Episode Listen Later Jul 31, 2024 27:09

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.

What is New in Eosinophilic Esophagitis (EoE) Research and Treatments?

HealthcareNOW Radio - Insights and Discussion on Healthcare, Healthcare Information Technology and More

Play Episode Listen Later Jul 11, 2024 21:44

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.

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PayerTalkCE: Managing Eosinophilic Esophagitis (EoE): Collaborative Care and the Patient Journey

Play Episode Listen Later Jun 5, 2024 28:27

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/

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Budesonide Oral Suspension Improves Outcomes in Eosinophilic Esophagitis

Evidence-Based GI: An ACG Publication and Podcast

Play Episode Listen Later May 15, 2024 19:10

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Eosinophilic Esophagitis (EoE): Insight for Non-GI Advanced Practice Practitioners

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Play Episode Listen Later May 14, 2024 23:27

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.

Eosinophilic Esophagitis (EoE) And Pregnancy: What Primary Care and OB-GYN Providers Need To Know

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Play Episode Listen Later May 2, 2024 26:28

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.

How is Eosinophilic Esophagitis (EoE) Treated in Children?

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Play Episode Listen Later Apr 24, 2024 27:22

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.

Mike Wilsey - Esophageal Strictures in Children