Investigating Airway Symptoms in Eosinophilic Esophagitis (EoE)

Diagnostic delay of eosinophilic esophagitis (EoE) is significant, and efforts are needed to raise awareness and reduce prolonged symptoms and complications. Airway and swallowing symptoms often overlap, especially in children, complicating diagnosis and increasing delays. This study aims to report the range of airway presentations in pediatric EoE patients and identify independent predictors of an EoE diagnosis in patients with aerodigestive symptoms.

We conducted a retrospective case-control study of pediatric patients < 7 years with histologically confirmed EoE managed in an aerodigestive clinic at a tertiary pediatric center. Variables included demographics, atopic comorbidities, risk factors, airway and dysphagia symptoms, and adaptive eating behaviors. EoE cases were age-matched to controls with aerodigestive issues and no EoE. Multivariate regression analysis identified independent predictors of EoE.

Fifty EoE patients were included, along with 50 controls. The mean age was 2.4 years, with 70% male. Common EoE symptoms included solid food dysphagia (62%), food pocketing (62%), and self-reported food allergies (72%). Airway symptoms included chronic cough (38%) and choking (32%). Multivariate analysis identified food allergy (OR 15.7) and food pocketing (OR 11.81) as independent predictors, while dysphagia with liquids (OR 0.058) and recurrent pneumonia (OR 0.022) were negative predictors.

Airway symptoms in pediatric EoE can overlap with other conditions, complicating diagnosis. Key features such as adaptive eating behavior and food allergies should raise suspicion for EoE.