Gastroenterology Today Summer 2021

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NEWS EoS Network launches ground breaking online educational series for patients, clinicians & the general public ‘An urgent need to raise awareness of this poorly understood condition’ To mark National Eosinophilic Awareness Week, the charity EoS Network launched a series of publicly available webinars to shed light on Eosinophilic Gastrointestinal Disease (EGID), an underdiagnosed set of chronic conditions which affect the oesophagus and/or lower gut and creates lifelong difficulties with swallowing, eating and digestion. Eosinophilic Diseases are immune-mediated, most probably caused by food allergies or other environmental triggers which occurs in the upper gut (Eosinophilic Oesophagitis) and/or the lower gut (Eosinophilic Gastritis, Eosinophilic Gastroenteritis, Eosinophilic Colitis). In the most common of these conditions, Eosinophilic Oesophagitis (EoE) this immune response results in inflammation of the mucosa in the oesophagus which, if left untreated, can lead to oesophageal remodelling including the formation of strictures or furrows. In turn this creates difficulties with swallowing certain foods or tablets including food sticking or even food obstructions. (SEE NOTES). In the UK it is the single most common reason for emergency admission to A&E for food bolus (obstructions) removal. 1 Patients with EoE report living with constant fear of choking, often avoid ‘tough’ ‘chewy’ foods and are embarrassed to eat with others or in public due to coughing fits and/or retching when food sticks. They often develop avoidance tactics such as eating with lots of water or eating very slowly. As a consequence, understandably some develop anxiety around eating and socialising. Often misdiagnosed as GORD (gastrooesophageal reflux disease) 2 or heartburn, many sufferers go undiagnosed due to lack of clinical and general awareness. Research has found that the average time to receive a diagnosis is around eight years 3 ‘As a relatively newly recognised disease, it is extremely important that we improve eosinophilic gastrointestinal disease awareness amongst the public, patients and healthcare professionals,’ says Amanda Cordell, CEO of the EoS Network. ‘These webinars provide a valuable resource for all these groups and feedback has been extremely positive not only for patients but also Health Care Practitioners (HCPs) who are eager to learn more about this disease.’ The series of webinars, which have been supported by the National Lottery Community Fund in conjunction with government Covid 19 funding, are led by experts from across the field of gastroenterology, dietetics and allergy. They provide a complete overview of Eosinophilic Oesophagitis, covering topics such as the role of allergy in EoE, emergency issues, long term management and dietary solutions, along with information on paediatric care and on the more complex EGIDs. They will go live on the EoS Network website during the Awareness Week and will be available for anyone to access at www.eosnetwork.org ‘Along with these webinars, we also provide educational tools, support and other resources via our educational hub,’ explains Amanda. ‘In WHY NOT WRITE FOR US? GASTROENTEROLOGY TODAY - SUMMER 2021 Gastroenterology Today welcomes the submission of clinical papers and case reports or news that you feel will be of interest to your colleagues. Material submitted will be seen by those working within all UK gastroenterology departments and endoscopy units. All submissions should be forwarded to info@mediapublishingcompany.com If you have any queries please contact the publisher Terry Gardner via: info@mediapublishingcompany.com 28
NEWS addition, we host a dedicated network section for registered healthcare professionals from around the world, allowing them to exchange advice, research and support on treating these unpleasant and life changing conditions.’ ‘EoE is a chronic disease that, if left untreated, can cause a severe food obstruction requiring emergency medical removal. If you are having the symptoms, we describe on our website then you should discuss them with your GP without delay.’ ‘In the meantime, vital research continues into the rarer, more complex lower gut eosinophilic diseases which are severely life impacting, an area where currently patients remain desperate for emerging clinical guidelines and treatments.’ 6 For more information or to interview Amanda Cordell, please contact Graeme Whitcroft at Healthy PR on 07793980500 or GraemeWhitcroft@healthypr.co.uk About the EoS network charity The EoS Network works to ensure that every person with an Eosinophilic Gastrointestinal Disease receives a prompt accurate diagnosis, the right treatment for them and support to live with their condition. Its vision is for a world where everyone with an Eosinophilic Gastrointestinal Disease can eat without pain. The EoS Network provides information and support for patients and their families, a global platform for clinicians and researchers, educational resources and events and works with medical bodies, manufacturers and funders to ensure that the patient’s voice is heard. Notes on EoE EoE is clinically characterized by oesophageal dysfunction and histologically characterized by an eosinophil-rich inflammation, most probably caused by common food allergies or other environmental triggers. Often misdiagnosed as GORD, 2 adult symptoms include dysphagia, bolus obstruction and chest pain related to swallowing, heartburn and regurgitation. In children they can include reflux-related symptoms, nausea, vomiting, abdominal pain, refusal to eat or failure to grow. 2 Untreated EoE can lead to oesophageal remodelling including the formation of strictures and EoE is the cause of more than 50% of all emergency presentations for oesophageal food bolus Current clinical guidelines can be found @ impactions. 1 https://www.eosnetwork.org/medicalguidelines Annual incidence rates of EoE in western countries are 10 per 100,000 with prevalence References rates of 86 per 100,000. 4 However, for patients with oesophageal symptoms who undergo 1. Prevalence of eosinophilic oesophagitis in gastroscopy the prevalence is 7% whilst in adults presenting with oesophageal food patients with dysphagia and bolus obstruction, bolus obstruction. World J Gastrointest prevalence increases to 23-50%. 1 Many Pharmacol Ther 2015;6:244–247. patients have a history of atopy, particularly Heerasing N, Lee SY, Alexander S, et al asthma, allergic rhinitis and eczema. 5 2. Eosinophilic esophagitis N Engl J Med. 2015;373(17):1640–8. Furuta GT, Katzka EoE only received classification in the 1990s DA. and disease awareness, amongst both 3. Gastrointest Pharmacol Ther 2016; 7(2): clinicians and the general public, is thought to 207-13. Ahmed M. World J be low. Currently, average time to diagnosis 4. Limketkai BN et al Gut 2019 ; 68 : 2152- is up to 8.1 years. 2 Due to the patchy nature 2160 of the disease, diagnosis requires 6 biopsies 5. Aliment Pharmacol Ther 2016; 43(1): 3-15. to be taken from around the oesophagus Arias Á et al via endoscopy. Diagnosis is defined by 6. Eosinophilic gastrointestinal diseases histological presence of eosinophils ≥15hpf. below the belt https://doi.org/10.1016/j. jaci.2019.10.013 https://www.jacionline. Treatment for EoE is focused around three org/article/S0091-6749(19)31367-3/pdf areas: dietary exclusion, drugs and dilatation. Pesek RD Rothernberg ME Dietary exclusion is generally considered hard to maintain and costly. Dilatation, ScheBo_GastroToday_Aug_2020 carried out Registered Multi-Ad_Address_Change Charity 1143267 when the disease has progressed to oesophageal strictures, is an invasive procedure which manages the symptoms but not the cause of EoE and often has to be repeated. Until recently, all drug treatments were off-label and topical steroid therapy was not optimised for delivery to the oesophagus. However, NICE and the SMC have now recommended budesonide orodispersible tablet (Jorveza ®) for active EoE in adults, a treatment option designed to reach the area of inflammation in the oesophagus (final NICE guidance due 23rdJune). GASTROENTEROLOGY TODAY - SUMMER 2021 29
Page 1 and 2: Volume 31 No. 2 Summer 2021 Gastroe
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