{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 5, Ep 1 of 2: Eosinophilic Esophagitis: Diagnosis Through Refractory Disease","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/6e2a3eb3\"></iframe>","width":"100%","height":180,"duration":1570,"description":"Every diagnostic criterion and every drug in the EoE ladder is\ndownstream of one mechanism: a Th2 allergic response to food allergen\nin a susceptible host that ends in fibrosis, rings, and impaction if\nuntreated. Hold the cytokine story and the 15-eosinophil threshold, and\nthe diagnosis, the EREFS score, and the treatment ladder follow.\n \nThe case. A 32-year-old atopic man presents with a food bolus impaction. After it\nis cleared, what biopsies do you take, how many, and what threshold\nmakes the diagnosis?\n \nTopics covered\n\nTh2 mechanism: IL-5 and IL-13 driving eosinophil recruitment and remodeling\nThe diagnostic threshold: at least 15 eosinophils per high-power field\nBiopsy strategy: multiple levels, proximal and distal, even on normal-looking mucosa\nEREFS endoscopic score: edema, rings, exudates, furrows, strictures\nDemographics: atopic men in the third and fourth decades, food impaction as the presentation\nPPI as first-line therapy (PPI-responsive EoE folded into the disease)\nTopical swallowed steroids: budesonide and fluticasone formulations\nDietary elimination: empiric six-food and step-up approaches\nDupilumab for refractory or steroid-dependent disease\nDilation for fibrostenotic strictures once inflammation is controlled\n\n \nKey decisions\n\nAny adult food bolus impaction gets esophageal biopsies at that endoscopy, even if the mucosa looks normal, because EoE is a histologic diagnosis\nTake biopsies at multiple levels (proximal and distal): EoE is patchy and a single-site sample misses it\nPPIs are now first-line EoE therapy, not a rule-out step: PPI-responsive eosinophilia is EoE, not a separate entity\nTreat the inflammation before dilating a stricture: dilation addresses fibrosis but does not treat the disease\nRefractory or steroid-dependent EoE escalates to dupilumab rather than open-ended steroid escalation\n\n \nFor the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.\nQuestions or feedback: hello@boardpearls.com.","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}