Updates in Eosinophilic GI Disease Management, With Amy Stewart, NP

Eosinophilic gastrointestinal (GI) diseases are gaining greater attention as both recognition and understanding of these conditions expand. Eosinophilic esophagitis (EoE) remains among the most well-studied, but related disorders like eosinophilic gastritis and enteritis, while still rare, are gaining traction.

At the 2025 Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) conference, eosinophilic GI diseases took center stage as the meeting held its first-ever EoE Bootcamp, offering a broader overview of various rare but increasingly recognized eosinophilic disorders.

While estimates of its prevalence vary, recent research yielded a prevalence rate of 1 in 617 in 2022 in those < 65 years of age and 1 in 1562 in 2017 in those ≥ 65 years of age. Standardized to the US population, the overall prevalence was approximately 1 in 700, with associated annual costs estimated to be $1.3 billion in 2024 dollars.1

In 2025, the American College of Gastroenterology released an update to the previous 2013 version of its EoE Clinical Guideline, recognizing paradigm shifts in disease diagnosis and management, increases in knowledge about EoE risk factors, natural history, and pathogenesis, and development of validated outcome metrics.2

“I think for those of us in practice, it's always really exciting when we have guidelines to kind of guide our clinical practice and to help us make decisions, but also help with insurance authorizations and getting what we need for our patients based on the available data,” Amy Stewart, NP, a GI Nurse Practitioner at Capital Digestive Care, explained to HCPLive.

She notes that an ongoing question in the field is whether EoE is truly becoming more prevalent or if clinicians are simply better at diagnosing it—likely a combination of both. A key gap in care, Stewart explains, is that nearly half of patients presenting to the emergency department with food impaction are lost to follow-up. However, the updated guidelines now recommend that gastroenterologists obtain biopsies during endoscopy at the time of impaction clearance, representing a major step forward in ensuring pathology results are available and patients are appropriately referred for treatment.

“Hopefully, if we are taking biopsies, if our GI colleagues are doing that, and then getting the pathology results back a week later, et cetera, that really helps stop the leak, if you will, and get patients to clinics so that they can be treated appropriately and not just recurring ER visits for food infections,” Stewart said.

Reflecting on her role as a new member of the GHAPP education committee and looking at what the rest of the 2025 GHAPP agenda has to offer, Stewart expresses enthusiasm about how well-rounded and flexible the meeting is, with boot camps for in-depth learning and workshop tracks designed to accommodate diverse practice needs.

“I'm really excited about the conference in general,” Stewart said. “I think we put together a really good, all encompassing agenda, and I'm also really excited about the expertise of our speakers this year in particular.”

References

1. Thel HL, Anderson C, Xue AZ, et al. Prevalence and Costs of Eosinophilic Esophagitis in the United States. Clinical Gastroenterology and Hepatology. 10.1016/j.cgh.2024.09.031

2. Dellon ES, Muir AB, Katzka DA, et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. The American Journal of Gastroenterology. doi:10.14309/ajg.0000000000003194