Dr. Michael Chew @mchew85
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GrepMed Gastroenterology-Hepatology Editor, Academic Hospitalist UC Davis Medical Center Internal Medicine, Yale Gastroenterology Fellow '22
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Eosinophilic Esophagitis (EoE) - Spectrum of Response
Non-response:
 • Histology: Persistent eosinophilia, ≥ 15 eos/hpf
 • Symptoms:
Eosinophilic Esophagitis ... (EoE) - Spectrum ... Endoscopy: Normal esophagus ... #Esophagitis #EoE ... #Response #diagnosis
Management of Jackhammer Esophagus or Esophageal Spasm
Step 1: Assess the severity of the motility disturbance
Step 2:
Management of Jackhammer ... Esophagus or Esophageal ... Consider further diagnostics ... Step 4: Medical Management ... #Jackhammer #Esophagus
Eosinophilic Gastroenteritis: Treatment Options Based on Severity of the Disease
Mild:
 • Trial of PPI
 • Trial
Eosinophilic Gastroenteritis ... • Additional diagnostic ... as CT scan #EoE ... #Eosinophilic # ... Gastroenteritis #Treatment #management
Eosinophilic Esophagitis (EoE) - Endoscopic ReFerence Score (EREFS)
Edema (Loss of vascular markings):
 - Grade 0: Distinct
Eosinophilic Esophagitis ... (EoE) - Endoscopic ... Present #EREFS #EoE ... #Eosinophilic # ... ReFerence #Score #diagnosis
Secondary Causes of Esophageal Eosinophilia (EoE) - Differential Diagnosis
 • Gastroesophageal reflux disease
 • Eosinophilic gastrointestinal
of Esophageal Eosinophilia ... (EoE) - Differential ... Diagnosis • Gastroesophageal ... wasting syndrome #Eoe ... #Differential #Diagnosis
Refractory Eosinophilic Esophagitis (EOE) Management Algorithm
Initial treatment with topical steroids
Initial treatment with dietary elimination
Continued EoE nonresponse:
Refractory Eosinophilic ... Esophagitis (EOE ... ) Management Algorithm ... #Eosinophilic # ... Esophagitis #Management
Acute Esophageal Necrosis
History: Hematemesis and/or melena (70%), Dysphagia, Epigastric/chest pain, Sepsis
Diagnosis EGD and Biopsy
Differential: Melanosis, Melanoma,
chest pain, Sepsis Diagnosis ... Klebsiella, pneumoniae) Management ... Necrosis #black #esophagus ... #diagnosis #management
Eosinophilic Esophagitis (EoE) - Treatment Algorithm
Medical therapy:
 • Proton pump inhibition
 • Topical corticosteroids
Diet therapy
 •
Eosinophilic Esophagitis ... (EoE) - Treatment ... testing directed #EoE ... #Eosinophilic # ... Treatment #Algorithm #management
Eosinophilic Gastroenteritis Management Algorithm
 - PPI x 8 weeks
 - Dietary therapy with Empiric Elimination or
Eosinophilic Gastroenteritis ... Management Algorithm ... x 4-8 wks #EoE ... #Eosinophilic # ... Gastroenteritis #Management
Eosinophilic Esophagitis (EoE) - Topical Corticosteroids
 • Liquid - Budesonide - 1 mg PO BID -
Eosinophilic Esophagitis ... (EoE) - Topical ... for treatment of EOE ... @GIreview #Eosinophilic ... Corticosteroids #management