Childhood eosinophilic esophagitis in Bahrain: Prevalence, clinical characteristics, and treatment response

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disorder of the esophagus that commonly presents with dysphagia and food impaction. Delayed diagnosis and treatment may result in esophageal strictures. This study aimed to assess the prevalence, clinical characteristics, and treatment outcomes of pediatric EoE.

This retrospective cohort study reviewed children with suspected EoE managed at the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between 1995 and 2024. Diagnosis was established according to the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition criteria. Demographic data, clinical features, laboratory findings, endoscopic and histological results, treatments, and clinical outcomes were assessed. Clinical presentations were compared across age groups.

Among 29 children evaluated for suspected EoE, 17 (58.6%) met the diagnostic criteria, corresponding to a prevalence of 0.006%. Most cases were diagnosed within the past two decades. The majority were male (n = 12; 70.7%), with a mean age of 6.5 ± 4.2 years at presentation and 7.9 ± 8.1 years at diagnosis. Dysphagia (76.5%) and vomiting (64.7%) were the most common symptoms. Regurgitation occurred exclusively in infants and toddlers (P = 0.006). Gastroesophageal reflux disease (64.7%) and asthma (41.2%) were the most frequent associations. Peripheral hypereosinophilia was present in 75% of patients. Endoscopic findings commonly included white exudates (52.9%) and longitudinal fissures (47.1%). The median esophageal eosinophil count was 30 eosinophils/high-power field (interquartile range: 16.3-77.5). Treatment included proton pump inhibitors (94.1%), swallowed corticosteroids (82.4%), and elemental diets (23.5%). Over a median follow-up of 3.1 years (interquartile range: 0.5-4.7), clinical improvement was observed in 93.8% of patients, despite suboptimal treatment adherence in 29.4%.

Pediatric EoE is rare in Bahrain but represents an evolving and potentially serious chronic condition. Symptom overlap with other gastrointestinal disorders may delay diagnosis. Targeted therapies are effective in achieving clinical improvement, even in the context of suboptimal adherence.