Piecing Together
the Puzzle
By putting the pieces together, we can
reveal the whole EoE patient picture
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Age at diagnosis: 31
of asthma, negative
for EoE
3 episodes per week
Heartburn
Click here to watch a short video to learn more about Tim*
Which disease domains would you
assess first in this adult patient with EoE?
Drag and drop the pieces into the boxes, with the leftmost box reflecting
the first disease domain you would use to assess the EoE status of
Tim.*
LATE BREAKING!
Tim* just informed you that he had to go to the emergency room because food got stuck during an anniversary dinner with his wife.
Assessing EoE disease domains for Tim*
Drag and drop the pieces into the boxes in the order you would assess first for Tim.*
of others placed this
piece similarly
of others placed this
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of others placed this
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Dysphagia
Quality
of Life
Histology
(eos/hpf)
Endoscopic
Reference Score
(EREFS)
1
2
3
4
Assessment order
Now let’s look at Tim’s* disease characteristics
based on the different EoE disease domains
Assessing EoE disease domains for Tim*
1
2
3
4
Assessment order
LATE BREAKING!
Tim* just informed you that he went to the emergency room a few
weeks ago because he couldn’t swallow chicken that got stuck
during his anniversary dinner with his wife.
to watch a short video to learn more about this new information.
Given this new information, do you want
to rearrange the order of the pieces?
1
2
3
4
Assessment order
Answer the questions to unlock the pieces
Each piece brings us closer to understanding the full EoE patient picture for Tim.*
(Answer all the questions quickly to make a new Best Time)
Try again
Answer again to unlock the piece.
Histology
(eos/hpf)
If peak esophageal eosinophil count
is <15 eos/hpf, EoE symptoms will no
longer be experienced by the patient.
Histology
Correct: the answer is False
Nice work! You’ve unlocked a piece of the puzzle.
Histologic disease activity only moderately correlates with symptoms, which may persist, and fibrosis may still occur despite histologic remission in patients with EoE.1,2 Other histologic features such as basal zone hyperplasia may also persist in patients with <15 eos/hpf and contribute to long-term remodeling in EoE.3,4
EoE, eosinophilic esophagitis; eos/hpf, eosinophils per high-powered field.
1. Aceves SS, et al. Gastrointest Endosc. 2022;96(4):576-592.e1. 2. von Arnim U, et al. Clin Gastroenterol Hepatol. 2023;21(10):2526-2533. 3. Dellon ES, et al. Gastroenterology. 2022;163(1):59-76. 4. Hirano I, Aceves SS. Gastroenterol Clin North Am. 2014;43(2):297-316.
Dysphagia
If there is minimal dysphagia
reported by the patient with EoE,
there is no need to assess other
disease domains.
Dysphagia
Correct: the answer is False
Nice work! You’ve unlocked a piece of the puzzle.
Patients with EoE often develop coping mechanisms to adapt to their difficulty swallowing.1 EoE symptoms may also not correlate with endoscopic or histologic evidence of disease activity.2-4 Thus, endoscopy and biopsy sampling, and not just symptoms alone, are recommended to assess EoE activity.3,4
EoE, eosinophilic esophagitis.
1. Hirano I, Furuta GT. Gastroenterology. 2020;158(4):840-851. 2. Safroneeva E, et al. Gastroenterology. 2016;150(3):581-590.e4. 3. Aceves SS, et al. Gastrointest Endosc. 2022;96(4):576-592.e1. 4. von Arnim U, et al. Clin Gastroenterol Hepatol. 2023;21(10):2526-2533.
Endoscopic
Reference Score
(EREFS)
Which EREFS features in this endoscopic
EoE image reflect inflammation vs fibrosis?
EREFS is an acronym of the different endoscopic features assessed in this
validated grading system (Exudates, Rings, Edema, Furrows, Strictures).1,2
Drag each of the 5 features to the corresponding
box below.
Endoscopic
Reference
Score
(EREFS)
Correct:
Inflammation: Edema, Furrow, Exudate
Fibrosis: Ring, Stricture
Nice work! You’ve unlocked a piece of the puzzle.
Determination of “localized” vs “diffuse” inflammatory findings in the esophagus is recommended to assess EoE status.1,2 In addition, the prevalence of fibrotic features, such as an esophageal stricture, can be correlated with subepithelial fibrosis.1
EoE, eosinophilic esophagitis.
1. Schoepfer AM, et al. Gastroenterology. 2013;145(6):1230-1236. 2. Dellon ES, et al. Gastroenterology. 2022;163(1):59-76.
Quality of Life
How can EoE impact
patient quality of life?
Quality
of Life
Correct: E. All of the above
Nice work! You’ve unlocked a piece of the puzzle.
Anxiety and sleep disturbance also impact QoL and may be higher in patients with EoE than in the general population.1 It is important to assess QoL, which is considered by patients with EoE as one of the most important outcomes.2 Multiple validated measurement tools are available to assess patient-reported QoL, such as EoE-QoL-A in adults with EoE.3,4
EoE, eosinophilic esophagitis; EoE-QoL-A, Adult Eosinophilic Esophagitis Quality of Life
questionnaire; QoL, quality of life.
1. de Rooij WE, et al. Neurogastroenterol Motil. 2021;33(7):e14069. 2. Safroneeva E, et al. Aliment Pharmacol Ther. 2018;48(10):1082-1090. 3. Taft TH, et al. Aliment Pharmacol Ther. 2011;34:790-798. 4. Ma C, et al. J Allergy Clin Immunol. 2022;149(2):659-670.
New Best Time!
You’ve unlocked all the pieces!
You’ve unlocked all the pieces!
Due to the chronic, progressive nature of EoE, long-term management and regular clinical follow-up individualized for each patient’s needs are recommended.1-3
EoE, eosinophilic esophagitis.
1. Lucendo AJ, et al. United European Gastroenterol J. 2017;5(3):335-358. 2. Hirano I, et al. Gastroenterology. 2020;158(6):1776-1786. 3. von Arnim U, et al. Clin Gastroenterol Hepatol. 2023;21(10):2526-2533.
Drag and drop unlocked pieces into the boxes
By putting the pieces together, we can reveal the whole EoE patient picture for Tim.*
Drag and drop the pieces into the boxes below.
Histology:
92 eos/hpf
Dysphagia:
3 episodes/
week
EREFS:
Exudate: 2,
Rings: 1,
Edema: 1,
Furrows:
0,
Stricture: 1
Quality of
Life:
1/4
(0=very poor,
4=very good)
Only when assessing multiple disease
domains can the pieces be put together to
reveal the patient picture in EoE
Histology:
92 eos/hpf
Histology
Dysphagia:
3 episodes/
week
Dysphagia
EREFS:
Exudate: 2,
Rings: 1,
Edema:
1,
Furrows: 0,
Stricture: 1
Endoscopic
Reference
Score
(EREFS)
Quality of
Life:
1/4
(0=very poor,
4=very good)
Quality of
Life
Only when assessing multiple disease
domains can the pieces be put together to
reveal the patient picture in EoE
References
Additional ADVENT EoE Resources
- Aceves SS, et al. Gastrointest Endosc. 2022;96(4):576-592.e1.
- Dellon ES, et al. Gastroenterology. 2022;163(1):59-76.
- de Rooij WE, et al. Neurogastroenterol Motil. 2021;33(7):e14069.
- Hirano I, Aceves SS. Gastroenterol Clin North Am. 2014;43(2):297-316.
- Hirano I, et al. Gastroenterology. 2020;158(6):1776-1786.
- Hirano I, et al. Gut. 2013;62(4):489-495.
- Hirano I, Furuta GT. Gastroenterology. 2020;158(4):840-851.
- Lucendo AJ, et al. United European Gastroenterol J. 2017;5(3):335-358.
- Ma C, et al. J Allergy Clin Immunol. 2022;149(2):659-670.
- Safroneeva E, et al. Aliment Pharmacol Ther. 2018;48(10):1082-1090.
- Safroneeva E, et al. Gastroenterology. 2016;150(3):581-590.e4.
- Schoepfer AM, et al. Gastroenterology. 2013;145(6):1230-1236.
- Taft TH, et al. Aliment Pharmacol Ther. 2011;34:790-798.
- von Arnim U, et al. Clin Gastroenterol Hepatol. 2023;21(10):2526-2533.
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