{"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":841,"description":"Eosinophilic esophagitis explained from a single mechanism: IL-4 and IL-13 drive eotaxin, eosinophils flood the lining, and chronic inflammation lays down scar. This episode walks the diagnostic criteria, the inflammatory-versus-fibrotic endoscopy split, and the three drugs plus diet, then closes on refractory disease and the dupilumab-plus-dilation combined approach.\n \nTopics covered\n\nEoE pathophysiology and eotaxin signaling\nDiagnostic criteria and biopsy protocol\nDropping the PPI diagnostic trial\nEndoscopic inflammatory vs scarring features\nPPI, topical steroids, and elimination diet\nStep-up empiric food elimination\nRefractory fibrostenotic disease\nDupilumab dosing and esophageal dilation\n \n \nKey decisions\n\nDiagnose EoE with at least fifteen eosinophils per high-power field plus symptoms, after excluding other causes; no PPI trial needed because a PPI response is treatment, not a rule-out.\nTake at least six biopsies from at least two levels (upper and lower) because disease is patchy and distal-only sampling reads falsely negative.\nAny adult with a food impaction gets esophageal biopsies at the first endoscopy even if the mucosa looks normal.\nEndoscopy splits into inflammatory features (edema, exudates, furrows) that reverse with drugs and scarring features (rings, strictures) that need mechanical dilation.\nFluticasone is sprayed into the mouth and swallowed, never inhaled, with no food or drink for thirty minutes; budesonide is a viscous slurry with the same rule.\nRefractory fibrostenotic disease is treated with dupilumab dosed weekly (less frequent dosing clears eosinophils but fails to improve dysphagia) plus graduated dilation.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Eosinophilic and Infectious Esophagitis\nRead this episode:...","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}