Pediatric Eosinophilic Esophagitis: Challenges in Treatment and Long-Term Follow-Up

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease increasingly recognized in children. Despite growing awareness, diagnostic delays, heterogeneous presentations, and variable treatment responses continue to complicate management. This study aimed to describe the real-world clinical characteristics, atopic features, treatment patterns, and long-term outcomes of children with EoE and to identify practical challenges that may inform more effective management strategies.

This retrospective study included 50 children diagnosed with EoE between October 2020 and October 2025 at a tertiary pediatric center. Demographic, clinical, endoscopic, histopathological, and allergic data were reviewed. Symptom burden and adaptive behaviors were evaluated using the Gazi Eosinophilic Esophagitis Symptom and Adaptation Scale (GaziESAS).

Of the 50 patients, 33 (66%) were male. The median diagnosis age of 10.5 years with an estimated diagnostic delay of 1.6 years. At least one concomitant atopic disease was present in 36 patients (72%), most commonly allergic rhinitis in 24 (48%) and asthma in 16 (32%). Food sensitization was detected in 15 of 47 evaluated patients (31.9%), and patch test positivity in 15 of 49 patients (30.6%). All patients initially received proton pump inhibitors; topical corticosteroids and/or elimination diets were added as needed. Older age at diagnosis correlated with higher total GaziESAS scores (r = 0.524, p < 0.001), mainly due to adaptive behaviors (ρ = 0.457, p = 0.001). Females showed higher peak eosinophil counts than males (82.3 ± 37.3 vs. 49.6 ± 25 eosinophils/high-power field, p = 0.001). Complete histologic remission, defined as <15 eosinophils per high-power field in all follow-up endoscopies after the diagnostic procedure, was achieved in 25 patients (50%).

Pediatric EoE is characterized by diagnostic delays, underscoring the need for increased awareness among families and primary care pediatricians. The burden of repeated endoscopies highlights the importance of multidisciplinary care and developing less-invasive monitoring tools. Given the more aggressive inflammatory profile in females, closer follow-up in this subgroup may be warranted.