Eosinophilic esophagitis is poorly characterized in Latin America. We aimed to estimate its prevalence and describe its clinical, endoscopic, and histologic features, treatments, remission, and associated factors.

Cross-sectional analysis of a retrospective-prospective registry. The study included adults with confirmed eosinophilic esophagitis between 2014 and 2025, defined by symptoms of esophageal dysfunction and ≥15 eosinophils per high-power field. Factors associated with histologic remission were explored using logistic regression.

A total of 129 adults were included (72.9% male; median age, 43 years). Prevalence was 36 per 100,000 health plan members (95% CI, 27 - 47), and median diagnostic delay was 8.21 months. Dysphagia (75.1%) and food impaction (63.2%) were the predominant symptoms. Frequent endoscopic findings included furrows (30.4%), edema (24.9%), and rings (23.4%); 49% had a normal endoscopy. Treatments included proton pump inhibitors (88%), topical corticosteroids (45%), and an elimination diet (39%). Clinical remission was 51.2% and histologic remission was 34.3%. Food sensitization was associated with histologic remission (adjusted odds ratio, 3.31; 95% CI, 1.26 - 8.73; p = 0.015). Among those who achieved histologic remission, 28% continued to have an incomplete clinical response.

The local prevalence was at the lower end of the pooled global estimate (40.04; 95% CI, 31.10 - 48.98) and below the 2017 - 2022 estimate (74.42; 95% CI, 39.66 - 109.19), and lower than contemporary estimates from the United States and Spain, with methodological and population-related caveats. Normal endoscopies reinforce the need for biopsies when eosinophilic esophagitis is suspected. Histologic remission in one-third of cases highlights the need to optimize treatment and follow-up.