Considerations for Recognizing and Treating Eosinophilic Esophagitis in Pediatrics

Course Description

Discover the latest strategies for recognizing and managing Eosinophilic Esophagitis (EoE) in pediatric patients. This program explores disease progression, age-specific presentations, evidence-based treatment options, monitoring strategies, and best practices for transitioning EoE care into adulthood. Originally presented as a live webinar on 23 September 2025.

Course Objectives:

• Review the natural history and pathology of Eosinophilic Esophagitis (EoE).
• Examine how EoE presents in different age groups.
• Discuss treatment options and shared decision-making.
• Evaluate monitoring strategies.
• Discuss how to transition a pediatric patient to adult care.

Key Takeaways:

• Early recognition is critical. EoE is a chronic, progressive, immune-mediated esophageal disease that requires lifelong treatment. Identifying symptoms across age groups and making timely referrals to pediatric gastroenterology can help prevent long-term complications. 
• Treatment options include dietary elimination, proton pump inhibitors, swallowed topical steroids, and biologics. Dietary approaches range from the 6‑food elimination diet to more targeted options, such as 1‑food elimination, with milk elimination alone showing effectiveness in many patients.
• Transition to adult care should begin early, with active involvement of the patient in decision‑making. Adolescents may require new or repeated education about their condition to prepare them for independent management.

Related Questions:

• What is Eosinophilic Esophagitis (EoE)?
  EoE is an antigen‑driven, immune‑mediated esophageal disease that is chronic and progressive, requiring lifelong treatment. It is diagnosed by symptoms of esophageal dysfunction plus >15 eosinophils per high‑power field (eos/hpf) on biopsy. Symptoms vary by age.
  
• What complications occur if EoE is not treated?
  Untreated EoE can lead to longstanding inflammation that causes edema, exudates, and furrows in the esophagus, ultimately resulting in lamina propria fibrosis and potentially strictures that may require dilation. This can create ongoing symptoms, including food impactions, and may contribute to malnutrition as well as a decreased quality of life due to significant morbidity.
• What red flags should primary care providers watch for?
  In primary care, important red flags include slow or prolonged mealtimes, pocketing food, drinking frequently during meals to help swallow, and any history of weight plateau or growth faltering. Additionally, children with coexisting atopic conditions such as eczema, asthma, or allergic rhinitis may warrant closer evaluation, since these conditions are associated with EoE.
• How is EoE diagnosed?
  Diagnosis of EoE requires an esophagogastroduodenoscopy (EGD) with biopsy demonstrating more than 15 eosinophils per high‑power field. Importantly, proton pump inhibitor (PPI) failure is not required for diagnosis, and neither blood nor skin testing can identify specific food triggers in EoE.