Challenges in Dietary Therapy in Pediatric Eosinophilic Esophagitis (EoE)-A Narrative Review

Eosinophilic esophagitis (EoE) is a chronic, allergic, immune-mediated inflammation of the esophagus caused by food antigens. The prevalence in pediatric population is approximately 34 to 57 cases per 100,000 children, with a male to female ration 3:1. This number may be underestimated due to diagnostic challenges and variety of clinical presentations in different age groups. Diagnosis of EoE requires histopathological assessment of esophageal biopsies retrieved during gastroscopy, with at least 15 eosinophils per high-power field (HPF) in the esophageal tissue being the cut off value. According to recommendations, treatment options of EoE include dietary interventions (elimination diets), medical treatment (inhibitors of proton pump, steroids, biologics), and in some cases surgical intervention (dilation). Dietary intervention, such as elimination diets, target the triggering factors of the disease and, if supervised by professional nutritionist, have the least systemic side effects. On the other hand, depending on the number of allergens eliminated from the pediatric patients' diet, the quality of life both of the child and their caretakers may be compromised. Additional challenges such as nutritional risks, feeding disorders, financial burden, and social life impairment also have to be taken into consideration. On top of this, an effectiveness assessment of chosen therapy requires repeated endoscopic examination with several biopsies of the esophagus, further increasing diseases burden in EoE patients. Taking all of this factors into consideration, the main objective of this narrative review was to address challenges that pediatric patients with EoE on dietary treatment face with reference to current research and daily practice.