Eosinophilic Gastrointestinal Disorders: Perspectives from a Physician as a Patient

Educational Objectives

The goal of this program is to improve the management of elimination diet for eosinophilic gastrointestinal disorders (EGDs). After hearing and assimilating this program, the clinician will be better able to:

1. Optimize management of EGDs.

Summary

A case of eosinophilic gastrointestinal disorders (EGD): a period of intense abdominal pain, nausea, and early satiety in speaker led to the assumption that stress was the cause; over-the-counter antacids provided no relief; a severe episode of projectile vomiting indicated that something was serious; despite recognizing the symptoms, seeking immediate medical attention was delayed; instead, a self-prescribed nausea medication was used as an attempt at management; eventually, a visit to a primary care doctor led to laboratory tests, which showed concerning results; subsequent consultations with an allergist and gastroenterologist recommended an upper endoscopy and colonoscopy; undergoing the prescribed preparation process provided firsthand experience for speaker of what patients endure, fostering empathy for those in similar situations

Diagnosis: The EGD evoked a emotional response and in speaker investigation of various treatment options, (eg, elimination diet [ED], topical steroids, biologics) and the possibility of hypereosinophilic syndrome; without specialized training in allergy or gastroenterology, the terminology felt foreign to speaker; each patient experiences diagnosis differently; the ED was selected as the treatment, presenting challenges beyond nutritional sustenance, as food plays a significant role in social activities and daily life

Practical aspect of ED: patients undertaking ED must constantly analyze meals, which is not second nature for most people; learning to read nutrition labels becomes essential, yet many labels contain ambiguous phrases, eg, “may contain traces of milk,” creating uncertainty about whether certain foods are safe to consume; the distinction between “nondairy” and “dairy-free” is also misleading, highlighting the importance of accurate labeling for patients on ED

Role of dietitian: is crucial in navigating the challenges by providing a list of safe brands, significantly easing the burden of searching through ingredient lists; patients embarking on ED require these practical tools for success, as frustration can deter them from adhering to necessary dietary changes; the limited availability of suitable baked goods often leads to experimenting with homemade alternatives, resulting in varied outcomes; gradually reintroducing foods into the diet became a momentous occasion for speaker, with something as simple as eating a regular hamburger marking a significant milestone

Online resources: (eg, allergen menus for restaurants), proved invaluable in avoiding uncomfortable interactions at food establishments; without such tools, ordering food in public often led to confused stares and feelings of being a burden for speaker; providing patients with strategies to research and navigate these challenges is essential for their confidence and well-being; the necessity to make a homemade birthday cake underscored the difficulty of finding commercially available options that met dietary restrictions; birthdays are universal celebrations, yet dietary limitations can create anxiety about whether participation is possible

Conference on EGD: proved to be an emotional experience, reinforcing that dedicated professionals are researching and caring about this condition; it was reassuring for speaker to see allergen labels on the provided meals, a rare consideration even at major events; dining at a structured dinner with a preset menu highlighted the ongoing struggles of ordering food while managing multiple dietary restrictions

Other aspects: navigating conversations about personal dietary needs remains a challenge, with uncertainty about whether to provide explanations or simply state restrictions; reintroducing culturally significant foods was a profound experience for speaker that had been avoided because of common allergens; recognizing dietary components within traditional meals became second nature after the extensive process of elimination and reintroduction; encountering a young patient with an IgE-mediated nut allergy and celiac disease marked a turning point in understanding how personal experiences could positively impact others; practical knowledge of safe brands and local bakeries offering allergen-free options made a tangible difference in supporting the patient’s mother; when patients express interest in ED, equipping them with immediate, real-world solutions is crucial; delays in dietitian appointments necessitate providing interim guidance to help patients get started

Readings

Mayerhofer C, Kavallar AM, Aldrian D, et al. Efficacy of elimination diets in eosinophilic esophagitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(9):2197-210.e3. doi:10.1016/j.cgh.2023.01.019.

Disclosures

For this program, members of the faculty and the planning committee reported nothing relevant to disclose. Dr. Huang’s lecture includes information related to the off-label or investigational use of elimination diets in eosinophilic gastrointestinal disorders.

Acknowledgements

Dr. Huang was recorded at the Scripps Inaugural Eosinophilic Gastrointestinal Disease Conference, held on August 24, 2024, in San Diego, CA, and presented by the Scripps Conference and CME. For information about upcoming CME activities from this presenter, please visit https://www.scripps.org/conferenceservices. Audio Digest thanks the speakers and Scripps Conference and CME for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.50 CE contact hours.

Lecture ID:

GE390803

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.