ACP InternistSwallowing Gone Wrong in EoE

Eosinophilic Esophagitis: An Underdiagnosed Condition with Rising ED Visits

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease affecting the esophagus, often leading to symptoms like dysphagia and vomiting. Despite its low prevalence, the condition is underdiagnosed, contributing to a tripling of EoE-related emergency department (ED) visits over the past decade. This article delves into the importance of early diagnosis and management of EoE, particularly by primary care physicians, to prevent serious complications like food impaction.

HCN Medical Memo
For physicians, particularly primary care providers, recognizing the symptoms of EoE is crucial for early diagnosis and management. The condition is not only underdiagnosed but also associated with a rising number of ED visits, making timely intervention imperative. Referral to a gastroenterologist for endoscopic diagnosis is essential, and awareness of treatment options, including newly approved medications like dupilumab, can significantly impact patient outcomes.

Key Points:

• EoE has an estimated prevalence of 0.5 to 1 in 1,000 people but is often underdiagnosed.
• Annual EoE-associated ED visits tripled from 2009 to 2019 and are projected to double again by 2030.
• Gastroenterologists manage most EoE cases but rely on primary care physicians to recognize symptoms and make referrals.
• EoE commonly presents in patients with other allergic disorders like asthma and hay fever.
• Effective treatments include proton-pump inhibitors (PPIs), swallowed corticosteroids, and dietary therapy, although they are generally prescribed by a gastroenterologist.

“People are afraid of their business lunches or in public settings to eat because they’re worried that they’re going to have an embarrassing episode where the food gets stuck or they bring it back up at the table, so it’s very, very impactful to make the diagnosis and institute treatment.”
– Evan S. Dellon, MD, MPH, Professor of Medicine and Director of the Center for Esophageal Diseases and Swallowing at the University of North Carolina at Chapel Hill School of Medicine

Additional Points:

• EoE affects more men than women and is commonly diagnosed in adults in their mid-30s.
• Symptoms of EoE are often self-managed by patients, making diagnosis challenging.
• Dupilumab became the first FDA-approved treatment for EoE in 2022, but it is expensive and usually considered after other treatments have failed.
• There is no increased cancer risk for EoE, unlike Barrett’s esophagus, but untreated EoE can lead to serious complications like esophageal rupture.

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