Allergy, Asthma CE/CME ACCREDITED Watch Time: 36 mins

touchMDT Exploring eosinophilic oesophagitis: How can multidisciplinary management improve outcomes?

Watch leading specialists involved in the multidisciplinary care of patients with eosinophilic oesophagitis address the optimal management of this disorder.

Overview & Learning Objectives

Patient with eosinophilic oesophagitis

Allergist/immunologist and gastroenterologist

A consultant in allergy and immunology and a gastroenterologist discuss the environmental, genetic and immunological factors that contribute to the development of EoE.

Expert Spotlight
Prof. Jonathan Spergel
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Prof. Arjan Bredenoord
Amsterdam University Medical Center, Amsterdam, Netherlands

Prof. Jonathan Spergel, an allergist/immunologist, and Prof. Arjan Bredenoord, a gastroenterologist, discuss the complex pathophysiology of EoE, covering the environmental and genetic factors that contribute to its development and the typical endoscopic features seen during clinical examination.

Listen on the Go

Learn more Back to MDT Hub Time: 10:05
 
Gastroenterologist, allergist/immunologist and dietitian

A gastroenterologist, an allergist/immunologist and a dietitian partake in a case-based discussion of the presenting symptoms of EoE, patients’ nutritional needs and the long-term impact of untreated disease.

Expert Spotlight
Prof. Arjan Bredenoord
Amsterdam University Medical Center, Amsterdam, Netherlands
Prof. Jonathan Spergel
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Dr Isabel Skypala
Royal Brompton & Harefield NHS Foundation Trust, London, UK

Prof. Arjan Bredenoord, a gastroenterologist; Prof. Jonathan Spergel, an allergist/immunologist; and Dr Isabel Skypala, a dietitian, discuss presenting symptoms and the optimal management of EoE in a 33-year-old patient presenting in A&E with food impaction.

Listen on the Go

Learn more Back to MDT Hub Time: 11:00
 
Allergist/immunologist, gastroenterologist and dietitian

An allergist/immunologist, a gastroenterologist and a dietitian discuss the multidisciplinary care pathway of a patient with EoE.

Expert Spotlight
Prof. Jonathan Spergel
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Prof. Arjan Bredenoord
Amsterdam University Medical Center, Amsterdam, Netherlands
Dr Isabel Skypala
Royal Brompton & Harefield NHS Foundation Trust, London, UK

Prof. Jonathan Spergel, an allergist/immunologist; Prof. Arjan Bredenoord, a gastroenterologist; and Dr Isabel Skypala, a dietitian, engage in a case-based discussion on the dietary and pharmacological management approaches for EoE, including the potential role of emerging biological therapies.

Listen on the Go

Learn more Back to MDT Hub Time: 14:31
 
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Learning Objectives & Overview
Overview

In this activity, leading experts in eosinophilic oesophagitis (EoE) discuss the complex pathophysiology of this disorder, its clinical presentation and burden on patients, and partake in a case-based discussion on its optimal management by the multidisciplinary team, covering both dietary and pharmacological treatments.

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

Target Audience

This activity has been designed to meet the educational needs of adult and paediatric gastroenterologists, adult and paediatric allergists/immunologists, paediatricians, advanced nurse practitioners, physician assistants and practice nurses involved in the management of patients with eosinophilic oesophagitis.

Disclosures

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.

Faculty

Prof. Jonathan Spergel discloses: Consultancy fees from Allakos, Novartis, Regeneron Pharmaceuticals, Inc. and Sanofi. Grant/research support from Celgene, Novartis, Regeneron Pharmaceuticals, Inc. and Sanofi. Other financial or material support (royalties, patent, etc.) from UpToDate.

Prof. Arjan Bredenoord discloses: Advisory board/panel fees from Alimentiv, Arena Pharmaceuticals, Inc., AstraZeneca, Calypso Biotech, Dr. Falk Pharma, EsoCap, Laborie, Medtronic, Reckitt, Regeneron Pharmaceuticals, Inc. and Sanofi. Consultancy fees from Alimentiv, Arena Pharmaceuticals, Inc., AstraZeneca, Calypso Biotech, Dr. Falk Pharma, EsoCap, Laborie, Medtronic, Reckitt, Regeneron Pharmaceuticals, Inc. and Sanofi. Grants/research support from Nutricia and Thelial; Bayer, Dr. Falk Pharma, Gossamer Bio, Norgine and SST (relationships terminated). Speaker’s bureau fees from AstraZeneca, Dr. Falk Pharma, Laborie, Medtronic, Regeneron Pharmaceuticals, Inc. and Sanofi.

Dr Isabel Skypala discloses: Speaker’s bureau fee from Thermo Fisher Scientific (2021) (relationship terminated).

Content reviewer

Patrick Brady, MD., has no relevant financial relationships with an ineligible company to disclose.

Touch Medical Director

Kathy Day and Anne Nunn have 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 cpdsupport@usf.edu.

Accreditations

Physicians

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 (www.uems.eu).

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: 24 May 2022. Date credits expire: 24 May 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

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

  • Explain how the complex pathophysiology of eosinophilic oesophagitis (EoE) impacts diagnosis
  • Assess the symptoms associated with EoE and the impact of this progressive disease on patients
  • Evaluate how the emerging biologic treatment options for EoE may be incorporated into clinical practice
Faculty & Disclosures
Prof. Jonathan Spergel

Children’s Hospital of Philadelphia, Philadelphia, PA, USA

Jonathan M Spergel, MD, PhD, is Professor of Pediatrics at the Perelman School of Medicine at University of Pennsylvania, Chief of the Allergy Section at the Children’s Hospital of Philadelphia and Director of the Center for Pediatric Eosinophilic Disorders. read more

Prof. Spergel is board certified in paediatrics and allergy and immunology. He is a fellow of the American Academy of Allergy Asthma and Immunology (AAAAI), the American Association of Pediatrics, the Philadelphia College of Physicians, and others.  

Prof. Spergel’s research interests have focused on all aspects of food allergy and atopic dermatitis. Some of his important works were the discovery that peanut allergy can be outgrown, identification of genetic risk factors for eosinophilic oesophagitis (EoE) and the role of basophils in EoE. He has published over 250 articles in the field. He has spoken nationally and internationally in the field of EoE, food allergy and atopic dermatitis. Prof. Spergel is funded by the National Institutes of Health and multiple foundations, and he has conducted over 30 clinical trials in the field of allergy. 

Prof. Spergel has contributed to international guidelines for food allergy, EoE and atopic dermatitis. He has served on the board of the AAAAI. He is currently deputy editor for Annals of Allergy Asthma and Immunology.

Prof. Jonathan Spergel discloses: Consultancy fees from Allakos, Novartis, Regeneron Pharmaceuticals, Inc. and Sanofi. Grant/research support from Celgene, Novartis, Regeneron Pharmaceuticals, Inc. and Sanofi. Other financial or material support (royalties, patent, etc.) from UpToDate.

Prof. Arjan Bredenoord

Amsterdam University Medical Center, Amsterdam, Netherlands

Arjan Bredenoord, MD, is Consultant Gastroenterologist at the Amsterdam University Medical Center (AMC), and Professor of Neurogastroenterology & Motility at the University of Amsterdam in the Netherlands. read more

In his current work as a consultant gastroenterologist, Prof. Bredenoord is dedicated to patient care, scientific research and education in the field of benign oesophageal diseases. Prof. Bredenoord’s main focus is on achalasia, reflux disease and eosinophilic oesophagitis. He is one of the pioneers of high-resolution manometry and impedance monitoring of the oesophagus. The oesophageal clinic at the AMC hosts the largest population of benign oesophageal diseases in the Netherlands. 

Prof. Bredenoord is an author of over 250 articles, books and book chapters. He organizes regular courses in Europe, North America and Asia. He is past president of the European Society of Eosinophilic Esophagitis (EUREOS), member of the United European Gastroenterology (UEG) Scientific Committee and co-founder of the International High-Resolution Manometry (HRM) working group.

Prof. Arjan Bredenoord discloses: Advisory board/panel fees from Alimentiv, Arena Pharmaceuticals, Inc., AstraZeneca, Calypso Biotech, Dr. Falk Pharma, EsoCap, Laborie, Medtronic, Reckitt, Regeneron Pharmaceuticals, Inc. and Sanofi. Consultancy fees from Alimentiv, Arena Pharmaceuticals, Inc., AstraZeneca, Calypso Biotech, Dr. Falk Pharma, EsoCap, Laborie, Medtronic, Reckitt, Regeneron Pharmaceuticals, Inc. and Sanofi. Grants/research support from Nutricia and Thelial; Bayer, Dr. Falk Pharma, Gossamer Bio, Norgine and SST (relationships terminated). Speaker’s bureau fees from AstraZeneca, Dr. Falk Pharma, Laborie, Medtronic, Regeneron Pharmaceuticals, Inc. and Sanofi.

Dr Isabel Skypala

Royal Brompton & Harefield NHS Foundation Trust, London, UK

Isabel Skypala, RD, PhD, is Consultant Allergy Dietitian at the Royal Brompton & Harefield NHS Foundation Trust (RBHT), London in the UK. read more

She is also clinical lead for the Adult Food Allergy Service. This includes a unique food allergy/gastroenterology clinic run with a consultant gastroenterologist, and a bespoke service for patients with eosinophilic oesophagitis. Dr Skypala is also an honorary senior clinical lecturer at Imperial College London and co-leads the Food Allergy module of the Allergy MSc. 

Dr Skypala lectures at an international level and has authored many peer-reviewed articles and books. Her research has primarily been focused on plant food allergy in adults, including pollen food syndrome and lipid transfer protein allergy. 

Dr Skypala has spent the past 20 years developing the dietitian’s role in food allergy management. In 2014, she received the British Society of Allergy and Clinical Immunology William Frankland Award for services to clinical allergy, and the American Academy of Allergy, Asthma and Immunology Allied Health Professional Recognition Award in 2022.

Dr Isabel Skypala discloses: Speaker’s bureau fee from Thermo Fisher Scientific (2021) (relationship terminated).

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Question 1/5
Which of the following environmental factors has been shown to increase the risk of EoE development?

EoE, eosinophilic oesophagitis; ICU, intensive care unit.
Correct

Over the last decade, several environmental factors have been associated with the development of EoE, including preterm labour and neonatal ICU admission.1 A recent nationwide prospective study using Danish health and administrative registries found that, of several perinatal exposures analysed, preterm delivery and neonatal ICU admission were the early life risk factors most strongly associated with the development of EoE.2

Abbreviations

EoE, eosinophilic oesophagitis; ICU, intensive care unit.

References

  1. Lucendo AJ, et al. Ther Adv Gastroenterol. 2022;15:1–16.
  2. Kurt G, et al. J Allergy Clin Immunol. 2022;149:AB68.
Question 2/5
A 25-year-old patient presents to the A&E department with food impaction. He is referred for an endoscopy with biopsy to determine the cause. Which of these findings would you expect to see if the patient has a diagnosis of EoE?

A&E, accident and emergency; EoE, eosinophilic oesophagitis.
Correct

Mucosal oedema, vertical linear furrows and white exudates are all typical endoscopic findings in patients with EoE.1,2 Other signs of EoE include concentric mucosal rings (trachealization) and strictures.1,2

Abbreviations

EoE, eosinophilic oesophagitis.

References

  1. Muir A, Falk GW. JAMA. 2021;326:1310–8.
  2. Racca F, et al. Front Physiol. 2022;12:815842.
Question 3/5
Your 18-year-old patient presents with dysphagia that has become more severe over the past 5 years, and they report adapting their eating habits to accommodate this (chewing excessively and consuming large volumes of water with meals). Following endoscopy and biopsy, they are diagnosed with EoE. You have discussed treatment options together, but your patient is reluctant to try any of these. When discussing treatment options, which long-term consequences of untreated EoE would you explain to your patient?

EoE, eosinophilic oesophagitis.
Correct

The natural history of EoE is a key aspect of discussions with patients regarding their long-term prognosis and options for disease management strategies.1 As EoE is a progressive disease, if left untreated chronic inflammation can lead to oesophageal fibrosis, stricture, food impaction and, in some cases, perforations of the oesophagus.2,3 

Abbreviations

EoE, eosinophilic esophagitis.

References

  1. Dellon ES, et al. Gastroenterology. 2018;154:319–32.
  2. Kumar S, et al. Pediatr Res. 2020;88:345–7.
  3. Furuta GT, Katzka DA. N Engl J Med. 2015;373:1640–8.
Question 4/5
Your 45-year-old female patient has moderate atopic dermatitis and comorbid EoE. Her specialist prescribes the biologic agent, dupilumab, as an add-on treatment for the atopic dermatitis. In light of recently published data, how would you advise your patient regarding the possible effect(s) of dupilumab on their EoE?

EoE, eosinophilic oesophagitis.
Correct

A recently published retrospective chart review analysed outcomes in patients prescribed dupilumab for atopic dermatitis, asthma or nasal polyps who had a concomitant clinical diagnosis of EoE. Dupilumab was associated with a significant improvement in histologic and symptomatic control of concomitant EoE, as well as medication reduction/expansion of diet. Importantly, this study was conducted in paediatric patients (mean age 15 years) and adults may not exhibit as robust of a response to dupilumab therapy.

Abbreviations

EoE, eosinophilic oesophagitis.

Reference

Spergel B, et al. Ann Allergy Asthma Immunol. 2022;doi: 10.1016/j.anai.2022.01.019.

Question 5/5
Which of the following biologic agents currently in development target key components of EoE pathophysiology?

EoE, eosinophilic oesophagitis.
Correct

Both dupilumab and benralizumab are under investigation for the treatment of patients with EoE.1 Dupilumab targets the IL-4R⍺ subunit of IL-4 and IL-13 receptors, thereby inhibiting the IL-4 and IL-13 signalling that drives the type 2 inflammatory pathway in EoE.1–3 Dupilumab is currently approved for the treatment of moderate/severe forms of atopic dermatitis, asthma and nasal polyposis.2,3 Benralizumab is a fully humanized IL-5R⍺ subunit antibody which binds IL-5 receptors on eosinophils and basophils, thereby triggering apoptosis and a reduction in eosinophilic inflammation, a key component of EoE pathophysiology.1,4,5 Benralizumab is currently approved for severe eosinophilic asthma.4,5 

Abbreviations

EoE, eosinophilic esophagitis; IL, interleukin; R⍺, receptor subunit alpha. 

References

  1. Racca F, et al. Front Physiol. 2022;12:815842.
  2. FDA. Dupilumab highlights of prescribing information. 2021. Available at: www.accessdata.fda.gov/scripts/cder/daf/index.cfm (accessed 6 April 2022).
  3. EMA. Dupilumab summary of product characteristics. 2022. Available at: www.ema.europa.eu/en/medicines (accessed 6 April 2022). 
  4. FDA. Benralizumab highlights of prescribing information. 2019. Available at: www.accessdata.fda.gov/scripts/cder/daf/index.cfm (accessed 6 April 2022).
  5. EMA. Benralizumab summary of product characteristics. 2022. Available at: www.ema.europa.eu/en/medicines (accessed 6 April 2022).
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