Eosinophilic Esophagitis in Children

Eosinophilic esophagitis (EoE) is an emerging antigen-mediated disease of unknown etiology limited to the esophagus. EoE is a multifactorial disease typically characterized by T helper 2 inflammation. Pathogenesis is not entirely understood and is likely non-IgE mediated. Food allergens trigger EoE, stimulating the dysregulated immune cells through an impaired esophageal epithelial barrier. Clinical presentation of EoE depends on age and mainly includes food refusal, vomiting, abdominal or chest pain, dysphagia, and food impaction. Upper gastrointestinal endoscopy is the gold standard to diagnose and monitor EoE. The goal of treatment is to achieve clinical, endoscopic, and histological (“deep”) remission to prevent esophageal fibrosis and improve the quality of life. In children, cornerstones of therapy are proton pump inhibitors, topical steroids (swallowed fluticasone and viscous budesonide), and food elimination diets. Over recent decades, much progress has been made toward a greater understanding of the EoE pathogenesis and new therapeutic approaches. Dupilumab is the first biological therapy recently approved in the US for adolescents (≥12 years) and adults with active EoE. Due to its chronic nature, EoE management requires long-term therapy and regular follow-up.