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Expert Interviews
Allergy CE/CME accredited

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Diagnosing and treating patients with EoE: Tackling the difficulties

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Dr Eren is a clinical immunology consultant and clinical lead for the Department of Immunology at the University Hospital Southampton in the UK. read more

Through his role as a clinical immunologist, Dr Eren’s experience and expertise covers the assessment and management of patients with both primary and secondary immune deficiency disorders. As an allergist, his experience covers the investigation and management of a broad range of allergic disorders, including eosinophilic oesophagitis, hay fever, food allergy, urticaria and angioedema, and drug allergy.

Dr Eren also works with the immunology laboratory, giving advice regarding appropriate testing for immunological, allergic and rheumatological diseases and result interpretation.

Dr Efrem Eren discloses: Advisory board or panel fees from Dr Falk Pharma and Pharming. Speaker bureau fees from Dr Falk Pharma.

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Dr Nirmala Gonsalves is a professor of medicine in the Division of Gastroenterology & Hepatology at the Northwestern University Feinberg School of Medicine in Chicago, IL, USA. read more

At Northwestern University, she serves as the co-director of the Northwestern Eosinophilic Gastrointestinal Disorders Program and has authored over 60 publications and presented extensively at international society meetings, invited grand rounds and symposia focusing on eosinophilic gastrointestinal diseases.

Dr Gonsalves continues to serve as a steering committee member of The International Gastrointestinal Eosinophil Researchers and serves as a site principal investigator for the National Institute of Health funded U54 Grant Consortium of Eosinophilic Gastrointestinal Disease Researchers (PI-Rothenberg) with the mission to develop greater understanding of the pathophysiology of these disorders and improve the lives of patients. Locally, she also serves as the gastrointestinal division director of Faculty Development and Wellness and is a peer coach for the Department of Medicine.

Dr Nirmala Gonsalves discloses: Advisory board or panel fees from Sanofi Regeneron. Consultancy fees from Allakos, AstraZeneca and Bristol Myers Squibb. Speaker bureau fees from Sanofi Regeneron.

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Dr Jamal Hayat is a consultant gastroenterologist and honorary senior lecturer at St George’s University Hospitals, London, UK, having trained at Imperial College School of Medicine, London. read more

As part of his specialist training, he undertook an MD research degree into the use of advanced diagnostic techniques in upper gastrointestinal disease. His work has been presented at the American Gastroenterology Association, United European Gastroenterology Association and the British Society of Gastroenterology.

Dr Hayat runs a specialist clinic for patients with oesophageal disorders, including gastro-oesophageal reflux disease and oesophageal motility disorders such as achalasia, Barrett’s oesophagus and eosinophilic oesophagitis. He is a specialist advisor for the National Institute for Health and Care Excellence on gastro-oesophageal reflux disease and was a principal investigator in the UK for the first licensed treatment for eosinophilic oesophagitis. He is a co-author for the British Society of Gastroenterology guidelines on eosinophilic oesophagitis. He currently leads the Gastrointestinal Physiology Unit at St George’s Hospital and is involved in a number of internal and external research trials.

Dr Jamal Hayat discloses: Advisory board or panel fees from Dr Falk Pharma (relationship terminated). Grant/research support from Medtronic.

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  • A practice aid is available for this activity in the Toolkit
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Learning Objectives

After watching this activity, participants should be better able to:

  • Identify key clinical features of EoE in children and adults
  • Explain the diagnostic pathway for EoE and define the usefulness of minimally-invasive tests and tools for diagnosis and monitoring of EoE
  • Summarize the efficacy and safety data for biologics in patients with EoE

Three experts discuss the challenges related to recognizing, diagnosing and treating patients with eosinophilic oesophagitis (EoE) and highlight how advances in diagnostic tools and emerging treatments may impact future care.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

Allergists, immunologists, gastroenterologists, paediatricians, dietitians, specialty/advanced nurse practitioners, physician assistants and primary health care primary care physicians and nurses involved in the management of EoE.


USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.


Dr Efrem Eren discloses: Advisory board or panel fees from Dr Falk Pharma and Pharming. Speaker bureau fees from Dr Falk Pharma.

Dr Nirmala Gonsalves discloses: Advisory board or panel fees from Sanofi Regeneron. Consultancy fees from Allakos, AstraZeneca and Bristol Myers Squibb. Speaker bureau fees from Sanofi Regeneron.

Dr Jamal Hayat discloses: Advisory board or panel fees from Dr Falk Pharma (relationship terminated). Grant/research support from Medtronic.

Content reviewer

Angela M. Hill, Pharm.D., CRPh, has no relevant financial relationships to disclose.

Touch Medical Contributors

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact



This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 13 February 2024. Date credits expire: 13 February 2025.

If you have any questions regarding credit please contact

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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Diagnosing and treating patients with EoE: Tackling the difficulties
0.75 CE/CME credit

Question 1/5
Which of the following clinical signs is more commonly seen in pre-school aged children with EoE vs adults with EoE?

EoE, eosinophilic oesophagitis.

EoE is a disease that can be found in all age groups, and symptoms vary depending on the age of presentation. Clinical manifestations in infants and toddlers generally include vomiting, food refusal, choking with meals and, less commonly, failure to thrive. Predominant symptoms in school-aged children and adolescents include dysphagia, food impaction, and choking/gagging with meals, particularly while eating foods with coarse textures. The predominant symptom in adults is dysphagia; however, intractable heartburn and food avoidance may also be present.

EoE, eosinophilic oesophagitis.

Carr S, et al. Allergy Asthma Clin Immunol. 2018;14:58.

Question 2/5
While oesophageal biopsy through upper endoscopy remains the gold standard diagnostic test for EoE, which of the following minimally invasive tools shows the most promise to evaluate oesophageal inflammation in the clinical setting?

EoE, eosinophilic oesophagitis.

As upper endoscopy is an invasive and expensive procedure that sometimes requires general anaesthesia in children and conscious sedation in most adult patients, researchers have focused on the development of minimally invasive tools to evaluate oesophagus inflammation. The oesophageal string test, which is currently being validated, uses a specially designed coiled string to collect fluid and proteins from the oesophagus to measure the levels of eosinophil-derived proteins in this fluid. The test has shown good correlation with eosinophilic infiltration in oesophageal biopsy specimens in both children and adults.1
Endoluminal functional lumen imaging probes should not be used to diagnose EoE, but they may have a role in severity assessment and therapeutic monitoring.2

EoE, eosinophilic oesophagitis.

1. Barni S, et al. Ital J Pediatr. 2021;47:230.
2. Hirano I, et al. Clin Gastroenterol Hepatol. 2017;15:325–34.

Question 3/5
Your patient with a history of long-term dysphagia and food bolus impaction has undergone endoscopic and histological workup. Which of the following would best confirm a diagnosis of EoE in this patient?

EoE, eosinophilic oesophagitis; eos, eosinophil; hpf, high-power field.

The histological diagnosis of EoE is confirmed when 15 or more eosinophils are counted per high-power field in biopsy specimens from proximal/mid oesophagus. The threshold of 15 eosinophils per high-power field has been shown to have a sensitivity of 100% and specificity of 96%, and to reliably distinguish EoE from GORD, which is associated with lower counts of eosinophils and usually involves the distal part of the oesophagus.

EoE, eosinophilic oesophagitis; GORD, gastro-oesophageal reflux disease.

Visaggi P, et al. Therap Adv Gastroenterol. 2021;14:1–17.

Question 4/5
Your patient presents with dysphagia and a history of upper GI symptoms. Their upper endoscopy is normal. How would you proceed?

EoE, eosinophilic oesophagitis; GI, gastrointestinal.

Guidelines recommend that oesophageal biopsies are taken in all adults with endoscopic signs of EoE, or with symptoms of dysphagia and/or food impaction, even with a normal-appearing oesophagus. It is recommended to take at least six biopsies in total from at least two different anatomical sites within the oesophagus, targeting areas with endoscopic mucosal abnormalities.

EoE, eosinophilic oesophagitis.

Sorge A, et al. Curr Treat Options Gastroenterol. 2023;21:256–71.

Question 5/5
In the LIBERTY EoE TREET phase III clinical trial, which frequency of dupilumab 300 mg was associated with the best outcomes?

EoE, eosinophilic oesophagitis

The long-term efficacy and safety findings of the LIBERTY EoE TREET clinical trial (NCT03633617) support the use of weekly dupilumab for full control of eosinophilic oesophagitis, since dosing every 2 weeks was ineffective at improving dysphagia even after this relatively prolonged drug exposure.

EoE, eosinophilic oesophagitis.

Rothenberg ME, et al. Lancet Gastroenterol Hepatol. 2023;8:990–1004.

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