The American College of Gastroenterology (ACG) hosted its Annual Scientific Meeting & Postgraduate Course in Philadelphia, Oct. 25-30, 2024. ACG is a recognized leader in educating GI professionals and the general public about digestive disorders.

During the conference, attendees had the opportunity to participate in a number of sessions to further their understanding of eosinophilic GI disease, including clinical presentation, evaluation, and treatment of eosinophilic gastrointestinal disorders based on current evidence.

Attendees visited the APFED booth in the exhibit hall to pick up educational materials to share with their patients and to learn about professional resources, and to chat with us about the needs of patients.

Other meeting highlights are as follows:

• A session on esophageal disorders was hosted and included EoE and updates from the ACG Guidelines which are expected be published in early 2025. See this interview with Dr. Evan Dellon posted to the Gastroenterology Learning Network who summarizes the guidelines.
• Sanofi and Regeneron (makers of Dupixent® (dupilumab), a biologic approved in the U.S. to treat EoE) sponsored a number of special learning opportunities that spotlighted EoE, including two Product Theaters and a Satellite Symposium. Product theaters discussed how and why EoE management strategies should evolve as our understanding of disease pathogenesis grows. The other showcased how inhibiting two key cytokines can impact disease and the efficacy and safety of a treatment option. The Satellite Symposium equipped clinicians with the knowledge and skills necessary to optimize diagnosis and management of EoE in pediatric and adult patients. There were also several posters presented on dupliumab.
• The findings from a phase 3 clinical trial for a potential EoE treatment called cendakimab (a biologic being developed by Bristol-Myers Squibb) were presented. Read more in our blog post here.
• The local tolerability and efficacy of an extended release formulation of fluticasone (EP-104GI) to potentially treat EoE were presented as posters.

Many research posters related to eosinophilic GI disease were also presented throughout the conference. Just few highlights from the poster session are below. To access all of the posters, visit https://acgposters2024.eventscribe.net/

• “Prevalence and Costs of Eosinophilic Esophagitis in the United States” is research that reports prevalence of EoE continues to rise rapidly in the United States. In 2022, the prevalence was estimated at 1 in 617 for those under 65 years old, and 1 in 1,562 for those 65 and older. When standardized to the overall U.S. population, the estimated prevalence is around 1 in 700 people. This represents a substantial 5-fold increase since 2009. The rising prevalence of EoE has led to a significant financial burden, with estimated annual healthcare costs reaching $1.32 billion in 2024. Given EoE’s growing prevalence and impact, it is now considered a commonly encountered condition that should be considered for patients with upper gastrointestinal symptoms.
• “No Association Between Eosinophilic Esophagitis and Esophageal Cancer in United States Adults: A Case Control Study Co-incidence of EoE” described findings from one study cohort that EoE is not associated with development of esophageal cancer.
• “Predictive Artificial Intelligence Analysis of Determinants of Health Outcomes in Hospitalized Patients with Eosinophilic Esophagitis” aimed to use predictive AI to look at factors that influence health outcomes of those hospitalized for EoE, highlighting the potential of AI to help healthcare providers allocate resources,
• A number of posters about dupilumab (Dupixent®) were presented including favorable results from the Phase 3 KIDS study that assessed efficacy of this drug in children ages 1-12 years with improvements of histologic and endoscopic aspects of EoE up to week 52. Another poster, “Efficacy and Safety of Dupilumab in Patients With Eosinophilic Esophagitis: Pooled Analysis and a Systematic Review” explores the current research on dupilumab in EoE, presenting key findings from available studies suggesting this drug effectively induces histological remission and improves clinical outcomes in EoE patients. The safety profile appears favorable when compared to placebo, with low rates of total and serious adverse events.
• “Exploring Demographic Variations in Eosinophilic Esophagitis: A Nationwide Study of Hospital Admissions From 2019-2023” highlights important racial and gender disparities in the incidence of eosinophilic esophagitis (EoE). Higher prevalence among White and Black populations compared to other racial groups suggests potential genetic or environmental factors may influence EoE risk, and the findings underscore the need for healthcare strategies that are tailored to specific patient populations to improve treatment outcomes and efficacy in managing this condition.
• “Unmet Needs Among Patients with Eosinophilic Esophagitis Despite Biologic Use” describes a real-world analysis looked at patients with Eosinophilic Esophagitis (EoE) who use biologic medications as their main treatment. Even though the biologics improved their symptoms, the analysis found that most patients still had to adapt their eating behaviors.
• “Risk of Barrett’s Esophagus in Eosinophilic Esophagitis: A Multi-Center Research Network Analysis” utilized a multi-institutional network to assess BE risk in individuals with EoE and found a higher risk of BE in patients with EoE in their study cohort.
• “Understanding the Current State of Eosinophilic Esophagitis Research: Insights from ClinicalTrials.gov” reported the research landscape on Eosinophilic Esophagitis (EoE) is diverse, but heavily leans towards interventional studies, especially those exploring pharmacological interventions. The data also highlights an underrepresentation of federally funded research in the field. Given the prevalence of ongoing studies, this analysis serves as a valuable resource for clinicians, researchers, and policymakers engaged in EoE research and treatment.
• “Role of TSLP in an Experimental Mouse Model of Eosinophilic Esophagitis” TSLP contributes to inflammation in Eosinophilic Esophagitis (EoE). When researchers induced EoE in mice, TSLP levels increased in the esophagus. To test TSLP’s importance, researchers gave the mice an antibody to block TSLP. This reduced the number of inflammatory cells (eosinophils) in the esophagus by 60%. It also decreased other signs of EoE, like thickening of the esophagus lining. These results suggest TSLP plays a key role in driving the inflammation and tissue changes seen in EoE. Targeting TSLP could lead to new treatment approaches for patients in the future.
• “Family History of Eosinophilic Esophagitis or Other Eosinophilic Gastrointestinal Disease Is Not Associated With Non-Response to Topical Steroid Treatment in Eosinophilic Esophagitis.” This study examined whether clinical features or topical steroid treatment response differed between eosinophilic esophagitis (EoE) patients with and without a family history of EoE or other eosinophilic gastrointestinal diseases (EGID). In summary, they found that while EoE patients with a family history showed some initial presentation differences, family history itself did not emerge as a major risk factor for treatment outcomes.
• “Seasons of Eosinophilic Esophagitis: Pinpointing the Summer Summit of Exacerbations” This study found significant seasonal variation in eosinophilic esophagitis (EoE) presentations, with a peak during summer months. These findings suggest aeroallergens may exacerbate EoE, highlighting the importance of considering seasonal allergen exposure when managing EoE in adult patients.
• “Efficacy of Dupilumab on Facilitated Food Introduction in Eosinophilic Esophagitis” described the potential role of dupilumab in facilitating introduction of EoE trigger foods. Researchers conducted an open-label pilot study that evaluated the use of dupilumab in 21 patients with food-triggered eosinophilic esophagitis (EoE). Participants received dupilumab alongside standard EoE therapy and elimination of their trigger food, followed by a 12-month food reintroduction process. Dupilumab enabled the reintroduction of EoE trigger foods without exacerbating symptoms or compromising histological and endoscopic outcomes, effectively controlling symptoms, preserving histologic integrity, and preventing endoscopic progression. This suggests dupilumab has the potential to reduce the burden of dietary restrictions for EoE patients, thereby enhancing their quality of life.
• “Predictors of Patients Receiving No Medication for Treatment of Eosinophilic Esophagitis in the United States: Data from the TARGET-EGIDS Cohort” describes a real-world analysis to evaluate predictors for absence of recorded medications and prescriptions prior to or following an initial EoE diagnosis. Among newly diagnosed patients with EoE, ~1 in 10 had no recorded pharmacologic therapy. Older patients and those without complications were more likely not to receive a medication for EoE. Further evaluation, including whether alternative treatments were used and outcomes, is warranted for this group.
• “Gastroparesis in Patients With Eosinophilic Gastrointestinal Diseases is Associated With Increased Symptoms and Comorbid Conditions” In a study analyzing 526 participants from EGIDPartners.org (402 with EoE and 124 with non-EoE EGID), researchers found that 8% of participants had gastroparesis (GP), which is significantly higher than the 0.16% prevalence in the general U.S. population. GP was more prevalent in non-EoE EGID patients (16%) compared to EoE patients (5%), and patients with GP experienced increased symptoms including chest pain, abdominal pain, nausea, vomiting, and constipation. The study also revealed that EGID patients with GP were more likely to have atopic disorders (such as eczema and food allergies) and autoimmune or connective tissue disorders (like Raynaud’s and Ehlers Danlos syndrome). While the findings suggest a potential relationship between these conditions, further research is needed to establish a direct connection between EGIDs and gastroparesis.
• “Effect of Budesonide Oral Suspension on Dysphagia Symptom Outcomes in Patients With Eosinophilic Esophagitis: A Pooled Post Hoc Analysis of Data From a Phase 2 and a Phase 3 Trial” This post hoc analysis of pooled data from phase 2 and 3 studies examined the efficacy of budesonide oral suspension (BOS) 2.0 mg twice daily versus placebo in 410 patients with eosinophilic esophagitis (EoE). Using an adapted methodology to analyze Dysphagia Symptom Questionnaire (DSQ) scores, the study found that patients treated with BOS (n=263) showed significantly greater improvements in both 14-day and 7-day prorated DSQ scores compared to placebo (n=147) at weeks 4, 8, and 12 of therapy. The treatment groups had similar baseline scores, but BOS-treated patients demonstrated significant symptom improvement as early as week 4. These findings, consistent with the prespecified analysis, reinforce the effectiveness of BOS 2.0 mg twice daily in managing dysphagia symptoms in EoE patients over a 12-week treatment period.

Learn more about the 2024 ACG Annual Scientific Meeting & Postgraduate Course at acgmeetings.gi.org.