Flexing Your Clinical Muscles: EoE Cases to Strengthen Diagnosis and Treatment in Real-World Scenarios

So what is the underlying pathophysiology of EOE? So we know that EOE is a food antigen and arrow allergen driven chronic inflammatory condition of the esophagus.

It is primarily a epithelial barrier dysfunction along with an activated TH2 dysregulation that's driven by cytokines IL-13, IL-4, IL-5, and CCL-26.

And we have this chronic inflammatory cycle that's occurring in this genetically susceptible population that tends to be atopic.

With the chronic inflammation, it then leads to fibrosis and scarring.

And you can see in the far box with the active EOE inflammation and fibrosis that over time that that lumen of the esophagus gets very narrowed.

And then we have strictures and our patients are presenting with esophageal food impactions.

All right, so I'm up.

So how does the prevalence of EOE vary by age and sex? So we have some new epidemiologic data using databases that represent much of the United States.

And there's a couple of things to notice from these graphs.

These are data from 2009.

You can see males in the blue bars, females in the light blue bars.

And essentially, for all age ranges, there's a male predominance to EOE, although that gets a little less prominent as you get a little bit older.

And the next thing to see is if you compare 2009 to 2022, there's a huge increase across all age ranges in EOE.

There's a peak there around 15 to 19 years of age, and another peak sort of in the 40 to 49 years of age.

And with this, you can calculate a prevalence of 1 in 700, which is very common.

And you're seeing a higher prevalence in males than you are in females.

So what do current clinical guidelines recommend regarding the diagnosis and management of EOE? So the American College of Gastroenterology in 2025 published their diagnostic algorithm for EOE.

And still, this is defined as a clinical pathologic diagnosis.

So our patients are presenting with symptoms of GI dysfunction, obviously mostly esophageal, but in pediatrics, often feeding dysfunction.

Patients have modification and avoidance behaviors.

Both myself and Evan will talk about that from the pediatric and the adult side.

And a lot of these patients will have concomitant atopic conditions, family history of EOE or EGID.

But when you have the clinical suspicion, patients then undergo an endoscopy with biopsy.

Obtaining six biopsies from different levels of the esophagus is very important.

and assessing gross endoscopic findings with findings of edema, rings, exudates, furrows, and whether there's the presence or absence of a stricture.