Eosinophilic esophagitis—current management in children and adolescents

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus with increasing incidence and prevalence worldwide, particularly in children and adolescents. It is characterized by symptoms of esophageal dysfunction and histologically confirmed eosinophilic inflammation. Pathophysiologically, EoE is predominantly driven by an IgE-independent, type 2 immune response to food and aeroallergens in genetically predisposed individuals with impaired epithelial barrier function. Atopic comorbidities, including asthma, allergic rhinitis, atopic dermatitis, and food allergy, are common. Clinical manifestations are age-dependent and often nonspecific, particularly in younger children. While adolescents typically present with dysphagia and food impaction, infants and younger children more commonly exhibit abdominal pain, vomiting, feeding refusal, failure to thrive, and abnormal eating behaviors. Adaptive eating behaviors may further delay diagnosis. Diagnosis is established by esophagogastroduodenoscopy with multiple esophageal biopsies demonstrating at least 15 eosinophils per high-power field after exclusion of other causes of esophageal eosinophilia. The therapeutic goal is clinical and histologic remission to prevent fibrostenotic remodeling, stricture formation, and long-term functional impairment. Established treatment options include proton pump inhibitors, swallowed topical corticosteroids, and elimination diets. Dupilumab provides an additional targeted biologic treatment option, particularly for patients with refractory disease or pronounced type 2 inflammation, and may also improve concomitant atopic conditions. Given the chronic course of EoE, early diagnosis, structured long-term follow-up, and close interdisciplinary collaboration among pediatric gastroenterology, allergology, and nutritional medicine are essential. A well-coordinated transition from pediatric to adult care is crucial to ensure continuity of treatment and disease monitoring.