Systematic review of feeding difficulties in children with eosinophilic esophagitis: An EAACI Task Force report

The term "feeding difficulties" (FD) encompasses a range of phenotypes characterized by inadequate food intake and/or inappropriate eating habits for a given age. Eosinophilic esophagitis (EoE) is a chronic, immune-mediated condition often affecting children. It leads to esophageal dysmotility, potentially impacting feeding/eating. However, little is known regarding the true prevalence of feeding/eating difficulties in children with EoE. The main objective of this systematic review was to address this knowledge gap and determine the impact of FD in children with EoE. We searched eight international databases for all published studies from inception until March 2024. All publications were screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses, so a narrative synthesis of quantitative data was performed. A total of 3442 abstracts were assessed, 29 underwent full-text screening. Ten studies met eligibility criteria and were analyzed. Across these, 18 different terms to define FD and 6 diagnostic tools were used. All included papers reported quantitative data on the FD prevalence in children with EoE, ranging from 13% to 75.3%. Concomitant IgE food sensitization/allergy was common (26.2%-88%) but its impact on FD occurrence was unclear. The current literature suggests that FD is prevalent among children with EoE, particularly those with associated IgE-mediated food allergies. However, the heterogeneity of terminologies and diagnostic tools makes drawing conclusions challenging, as it might have impacted outcomes. Further research and guidance on the diagnosis and management of FD in children with EoE are needed to appropriately identify and manage such patients.