UVA Opens Dedicated Multidisciplinary Clinic for Adult Eosinophilic Esophagitis
At a Glance
- Eosinophilic esophagitis (EoE) is on the rise.
- UVA recently launched a multidisciplinary EoE clinic for adults.
- UVA specialists are actively involved in conducting research to better characterize the disease and to assess the effectiveness of treatments.
In recent decades, there has been a dramatic rise in the prevalence of allergic conditions, such as hay fever, asthma, food allergies and, more recently, eosinophilic esophagitis (EoE). Although the precise causes of EoE are not fully understood, the prevailing view is that a barrier dysfunction in the lining of the esophagus allows food allergens to enter the bloodstream, provoking an allergic response. Eosinophils and other allergy cells infiltrate the epithelial lining of the esophagus, causing inflammation and, if left unchecked, strictures and fibrosis.
“Like many allergic diseases, eosinophilic esophagitis crosses the line between medical specialties,” says Bryan Sauer, MD, a gastroenterologist at UVA Health System. Following on the success of an EoE clinic for children, Sauer joined forces with UVA colleagues Emily McGowan, MD, an allergist, and Bethany Blalock, RDN, a nutritionist, to create a dedicated EoE clinic for adults. “Our goal is to make it easier for patients with this condition to receive the carefully coordinated care necessary to manage it effectively,” Sauer says.
Adults with EoE typically present with difficulty swallowing, food impaction, persistent heartburn or upper abdominal pain. In the past, these symptoms were often attributed to acid reflux or patients failing to chew their food thoroughly, but as Sauer points out, EoE is the number one reason that individuals between the ages of 20 and 40 have difficulty swallowing. To determine if a patient has EoE, Sauer performs an endoscopy to assess the esophagus and takes a biopsy to determine if eosinophils are present.
As part of the treatment, McGowan tests patients for food allergies — foods containing wheat, dairy, soy, eggs, nuts and seafood are the most likely culprits. In some cases, EoE has also been associated with airborne allergens like pollen. Treatments include acid-suppressing medications called proton pump inhibitors, topical steroids to reduce inflammation, dietary changes to avoid the food triggers and endoscopies to widen the strictures. “We work closely with all our patients to develop an approach that works for them,” McGowan says.
McGowan notes that there is much ongoing research to better understand the risk factors, diagnosis and treatment of EoE. In addition to their practice, McGowan and Sauer are conducting research to better characterize the disease and to assess the effectiveness of treatments. They are also conducting a study to assess how common treatments affect patients’ quality of life. Ultimately, Sauer and McGowan hope to use biospecimens they are collecting to investigate the underlying etiology of EoE and establish risk factors for the disease.
Sauer believes that UVA’s multidisciplinary adult EoE clinic is one of only a handful of similar clinics in the United States. “This clinic epitomizes the patient-centered model of care we practice at UVA,” Sauer says. “By bringing to bear relevant expertise in a coordinated way, we believe we can improve patient outcomes and further our understanding of this increasingly diagnosed condition.”