Eosinophilic esophagitis: does age matter?

ABSTRACT

Introduction

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus with increasing prevalence worldwide. It is a multifactorial disease caused by a combination of immunologic, genetic, and environmental factors. The clinical presentation of EoE varies largely, especially between different age groups. While diagnostic criteria and therapeutic goals are similar in children and adults, there are differences in treatment, with a more cautious approach in children to avoid growth disturbances. In addition, close monitoring and follow-up are essential in children to ensure uninterrupted growth.

Areas covered

A search in PubMed/MEDLINE, EMBASE, and SCOPUS databases was conducted to identify relevant studies published between January 2010 and January 2023 to give an overview of the state-of-the-art of EoE epidemiology, diagnosis, and treatment while focusing on similarities and differences between the adult and the pediatric population.

Expert opinion

The current state of research indicates that while significant progress has been made in understanding and treating EoE, further research and advances are needed to optimize diagnostic strategies, tailored treatment approaches, monitoring, and follow-up, and improve long-term outcomes for patients. With further innovation, the management of EoE can become more precise and tailored, leading to better patient outcomes and improved quality of life.

KEYWORDS:

• Adult
• children
• Dupilumab
• Eosinophilic esophagitis
• food impaction

Article highlights

• Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus with increasing prevalence worldwide, with the highest prevalence reported in North America. EoE is a multifactorial disease influenced by immunologic, genetic, and environmental factors.

• The clinical presentation of EoE varies among different age groups, although the diagnostic criteria and therapeutic goals are similar in children and adults.

• Diagnosis in children and adults includes upper endoscopy with biopsies, and non-invasive diagnostic markers and monitoring tools are being explored.

• Although treatment approaches in both adults and children include dietary changes, proton pump inhibitors (PPIs), topical steroids, and biologic agents, they should be tailored to age, taking into account growth and minimizing side effects in the pediatric population.

• Elimination diets, such as elemental and empirical food elimination diets, can induce disease remission, but strict dietary restrictions may pose challenges.

• PPIs are a first-line treatment option. Topical steroids such as fluticasone and budesonide reduce inflammation and have been shown to be effective in achieving clinical and histological remission. Dupilumab has demonstrated efficacy in inducing and maintaining disease remission in both adults and adolescents.

• Endoscopic dilation is a viable treatment option for esophageal strictures in EoE patients.

• Key areas for improvement include early diagnosis, understanding clinical phenotypes, personalized treatment strategies, and standardized treatment goals.

• Further research is needed to expand pathophysiologic knowledge, refine diagnostic techniques, and optimize both medical and endoscopic therapeutic approaches.

• The future of the field lies in advances that enable targeted and personalized therapies, improve patient outcomes, and establish clear guidelines for diagnosis, treatment, and monitoring.

Declaration of interest

S Danese reports consultancy fees from AbbVie, Alimentiv, Allergan, Amgen, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Enthera, Ferring Pharmaceuticals Inc., Gilead, Hospira, Inotrem, Janssen, Johnson & Johnson, MSD, Mundipharma, Mylan, Pfizer, Roche, Sandoz, Sublimity Therapeutics, Takeda, TiGenix, UCB Inc., and Vifor. E Vespa reports consultancy fee by Sanofi and Dr.Falk. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

S.M., A.E., and E.V. conceived and planned the paper. G.M., G.C., and R.P. carried out the literature review. R.P., S.M., A.E., and E.V. contributed to the selection of papers for consideration. G.M., G.C., and A.E. wrote the manuscript with support from S.M., R.P., and E.V. S.M., A.E., and E.V. took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research.

Additional information

Funding

This paper was not funded.