Reducing Diagnostic Delays and Improving Follow-Up Care for EoE, With Rosa Yu, MD

Eosinophilic esophagitis (EoE) has rapidly evolved from a once-rare diagnosis to one of the most common causes of esophageal food impaction (EFI) in adults. Despite its increasing prevalence, many patients continue to experience delayed diagnosis, often presenting to the emergency department with dysphagia or food impaction before EoE is formally identified.

While it is widely recognized that early diagnosis is critical for prompt initiation of therapy to prevent persistent inflammation, disease progression, and repeat EFIs, in many centers, biopsies are not routinely taken during the initial endoscopy performed to address the obstruction, and patients may be discharged without clear plans for follow-up, contributing to missed or delayed diagnoses.

“I think there are 2 big factors,” Rosa Yu, MD, a GI fellow at Boston Medical Center, told HCPLive at the American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting. “One is under recognition of the disease, both by patients as well as physicians. Secondly, I think it's access to care.”

Seeking to address current quality gaps in EoE diagnosis and care, Yu and colleagues launched a quality improvement initiative aimed at increasing biopsy rates during index endoscopies for EFI and improving follow-up pathways for patients presenting with dysphagia. The project used a structured improvement framework to analyze barriers and streamline workflows between the emergency department and gastroenterology teams.

Interventions included education for gastroenterologists on the importance of collecting biopsies at the time of impaction management and training for emergency department clinicians to better recognize symptoms of EoE. The team additionally implemented a rapid referral pathway prioritizing patients discharged without an emergent endoscopy for an outpatient EGD within 2 weeks to ensure diagnostic evaluation occurred without delay. Multilingual patient education materials were also developed to reinforce the importance of GI follow-up after EFI or dysphagia.

Results presented at ACG 2025 showed that the intervention, biopsy rates during index EGDs increased from 44% to 100%, ensuring that every eligible patient received appropriate tissue sampling for diagnosis. For patients who presented with dysphagia but did not require emergent endoscopy, referrals to GI improved from 1.3% to 19.3% after the rapid referral process was introduced.

“I think what's exciting about this project is that what we did is so easily scalable and can really be applied in any institution,” Yu said. “Regardless of what system you're using in the EHR, I think that there are ways to build this in so that we can better connect patients to care.”

Looking ahead, Yu points to opportunities for addressing disparities in EoE diagnosis and care as the field’s understanding of its epidemiology continues to grow, particularly around non-White and older patients.

Editors’ note: Yu has no relevant disclosures.

References

1. Yu R, Sanfratello N, Leo MM, et al. From ED to EoE: Improving Practices for Timely Diagnosis. Presented at the American College of Gastroenterology (ACG)’s 2025 Annual Scientific Meeting. Phoenix, Arizona. October 27-29, 2025.

2. Murray FR, Kreienbuehl AS, Greuter T, et al. Diagnostic Delay in Patients With Eosinophilic Esophagitis Has Not Changed Since the First Description 30 Years Ago: Diagnostic Delay in Eosinophilic Esophagitis. Am J Gastroenterol. doi:10.14309/ajg.0000000000001950