Children and Adolescents Present Differently With Eosinophilic Esophagitis

pediatric throat pain
pediatric throat pain
Researchers sought to characterize eosinophilic esophagitis in children and adolescents.

Young children and adolescent patients present differently with eosinophilic esophagitis (EoE), according to study results published in the Journal of Pediatric Gastroenterology and Nutrition.

For the study, researchers sourced data from the European Pediatric Eosinophilic Esophagitis Registry (pEEr) registry, which was initiated in 2015 by the Eosinophilic Gastrointestinal Disorders Working Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Pediatric patients (N=582) with EoE were enrolled at centers in 9 European countries and Israel. Data on demographic and clinical characteristics, treatment, and outcomes were evaluated for trends on the basis of being a child (10 years of age; n=286) or adolescent (>10 years of age; n=296).

The children and adolescent groups were 62% and 60% boys, had a median age of 7.1 and 13.8 years at enrollment (P <.001), and were aged 6.3 (IQR, 3.7-8.3) and 12.4 (IQR, 10.3-15.1) years at symptom onset (P <.001), respectively.

Children had a significantly longer delay in diagnosis from symptom onset compared with adolescents (median, 2.1 vs 1.3 years; P =.01), respectively. A shorter time from symptom onset to diagnosis was observed among patients who had a sibling with EoE (median, 0.8 vs 1.8 years; P =.001), a food allergy (median, 0.7 vs 1.5 years; P =.001), and any allergic condition (median, 0.8 vs 1.6 years; P =.03). A longer delay in diagnosis was observed among patients aged younger than 6 years (median, 2.3 vs 1.1 years; P =.001) compared with their counterparts, respectively.

At symptom onset, more children had vomiting (20% vs 12%; P =.01) and failure to thrive (18% vs 8%; P <.001); fewer children presented with dysphagia (16% vs 33%; P <.001) or food impaction (14% vs 20%; P =.03); more children had comorbid dermatitis (22% vs 15%; P =.02), food allergy (38% vs 26%; P =.002), and a family history of allergy (58% vs 49%; P =.02) compared with adolescents, respectively.

At endoscopy, rings were observed among fewer children and more adolescents (13% vs 33%; P <.001) and more children had exudates than adolescents (48% vs 28%; P <.001), respectively.

During treatment, more adolescents responded to proton pump inhibitors (PPIs) than children (31% vs 22%; P =.03), respectively. After experiencing PPI failure, more adolescents were given topical steroids (TCS; 49% vs 32%; P =.01) and fewer

dietary intervention (34% vs 48%; P =.003) than children, respectively. No age-based differences in response to TCS or dietary intervention were observed.

Response to PPIs occurred more among boys (P =.03), adolescents (P =.03), and those with mild endoscopic abnormalities (P =.01) or without endoscopic abnormalities (P =.05).

The major limitation of this analysis was not considering EoE disease severity.

The study authors concluded, “This study confirms the heterogeneous nature of childhood EoE in Europe and Israel. Several clinical factors, such as a longer diagnostic delay, concomitant food allergies or atopic dermatitis, less specific symptoms (ie, vomiting and/or growth disturbances), inflammatory endoscopic lesions (exudates), and lower PPI responsiveness are more commonly reported in younger children compared [with] adolescents.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Oliva S, Dias JA, Rea F, et al. Characterization of eosinophilic esophagitis from the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN. J Pediatr Gastroenterol Nutr. 2022;75(3):325-333. doi:10.1097/MPG.0000000000003530