Background and aim Eosinophilic oesophagitis (EoE) is an emerging type 2 inflammatory disorder. We aimed to compare clinical and atopic profiles of paediatric-onset and adult-onset EoE. Methods We performed a retrospective cohort study using a database encompassing over five million individuals. Patients diagnosed with EoE between 2000 and 2025 were stratified by age at diagnosis: paediatric (<18 years) and adult (≥18 years). Demographic, laboratory, comorbidity and treatment data were extracted. Matched analyses were performed. Results Among 2496 patients with EoE, 1609 (64.5%) had paediatric-onset and 887 (35.5%) adult-onset. Compared with adult-onset, paediatric-onset patients exhibited higher rates of asthma (34.4% vs 28%, p<0.001), atopic dermatitis (41.2% vs 16.3%, p<0.001) and food allergy (34.4% vs 5.9%, p<0.001), along with greater peripheral eosinophilia (median 0.49 vs 0.30 K/µL, p<0.001). Adult-onset patients more frequently had allergic rhinitis (38.9% vs 30.1%<0.001) and nasal polyps (4.7% vs 0.6%, p<0.001). Findings persisted in matched analyses, with paediatric-onset patients showing significantly more asthma, food allergies and higher eosinophil counts. Conclusions Paediatric-onset and adult-onset EoE represent clinically distinct endotypes. Paediatric disease aligns with food-triggered, systemic atopy, while adult disease is more strongly linked to aeroallergen sensitisation and nasal polyposis. Recognising these divergent pathways is essential for tailored diagnostic and therapeutic strategies.
Eindor‐Abarbanel et al. (Fri,) studied this question.
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