Eosinophilic Esophagitis in the Older Adult - Current Trends and Future Considerations

Eosinophilic esophagitis (EoE) is a chronic inflammatory esophageal condition increasingly recognized across the age spectrum. Although EoE is traditionally associated with younger population, it also affects older patients aged 65 years and older. This review summarizes the current literature on EoE specifically in older adults, with a focus on clinical presentation, endoscopic and histologic findings, diagnostic challenges, management considerations, and gaps in current knowledge.

EoE is thought to be less frequently diagnosed in older patients, but the true prevalence in this population remains uncertain. Older patients may have overlapping symptoms and are likely to have comorbid conditions that can obscure the diagnosis, including age-related presbyesophagus and gastroesophageal reflux disease. Recent evidence indicates older adults are less likely to undergo esophageal biopsies during endoscopic evaluation for dysphagia, which may be a potentially barrier to diagnosis of EoE. Current treatment options for EoE include proton pump inhibitors, swallowed topical corticosteroids, dietary elimination, endoscopic dilation, and biologic therapy. However, evidence specifically addressing their efficacy and safety in older adults remains limited. EoE should be considered in older patients presenting with esophageal symptoms such as dysphagia, especially when symptoms persist despite treatment for more common conditions like GERD. Maintaining high index of suspicion and obtaining esophageal biopsies are important to reduce diagnostic delay in these patients. Management should be individualized according to patient goals, comorbidities, polypharmacy, nutritional status, and procedural risk. Further prospective studies involving adults aged 65 years and older are essential to better understand the epidemiology, appropriate management, treatment outcomes, and long-term consequences of EoE in the elderly population.