Eating behaviors in childhood eosinophilic esophagitis: A retrospective case-controlled study

Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease in the esophagus. It is associated with feeding difficulties. We aimed to assess eating behaviors in patients with EoE and compare them with controls. Methods: This case-controled study enrolled children aged 0–16 years where their eating/behavior scores were measured. Child Behavior Frequency Scores (CBFS) >61, Parents Feeling/strategies Frequency Score (PFSFS) >20 and the Total Behavioral Pediatric Feeding Assessment Scores (BPFAS) >84 were considered as abnormal results. Results: The study involved 80 children with 40 in the EoE group and 40 in the control group. The mean age of EoE diagnosis was 6.4 ± 4.0 years, while the mean age of the control group was 8.4 ± 4.0 years. Fifty four of the 80 patients (67.5%) were male. There was a significant difference between the EoE patients and the controls regarding child feeding difficulties. The mean scores were as follows: problems chewing food, 2.4 ± 1.6 in EoE vs. 1.3 ± 0.7 in controls, P < 0.001; drinking more than eating, 2.6 ± 1.7 in EoE vs. 1.6 ± 1.2 in controls, P = 0.002; taking longer than 20 min to finish a meal, 3.3 ± 2.0 in EoE vs. 2.2 ± 1.5 in controls, P = 0.008; and parents get frustrated or anxious when feeding the child, 2.8 ± 1.7 in EoE vs. 1.3 ± 0.8 in controls, P < 0.001. Our results confirmed that the mean frequency score for parent feelings and strategies was significantly higher in the EoE group compared to controls (24.2 ± 7.4 vs. 18.9 ± 7.6); 95% confidence interval (CI), 2.0–8.7, P = 0.002. Additionally, the mean frequency score for Child behavior was 60.3 ± 16.9 in EoE vs. 43.5 ± 12.7 in controls; 95% CI, 10.2–23.4, P < 0.001. Furthermore, the total BPFA frequency mean score was 84.5 ± 22.7 in EoE vs. 62.3 ± 19.3 in controls; 95% CI, 12.8–31.5, P < 0.001. Conclusions: This is the first pediatric study demonstrating CBFS, PFSFS and total BPFAS used as measures for scoring the symptoms of EoE. Our results suggest that the identification of altered eating behavior was strongly associated with EoE in comparison to controls.