Pediatric and adult eosinophilic esophagitis: different phenotypes or different diseases?

What is eosinophilic esophagitis (EoE)?

Eosinophilic esophagitis (EoE) was first recognized as its own entity in the early 1990s. Several cases described adults suffering from dysphagia and children with refractory reflux symptoms, with eosinophil-predominant infiltration, distinguishing EoE from gastroesophageal reflux disease (GERD).

What is the cause of EoE?

EoE represents a T-helper (Th)2-type inflammatory disease. Familial occurrence and disease association with single-nucleotide polymorphisms (SNPs) points to genetic factors.

There is a significant allergic bias in the EoE population, with the majority of patients having concurrent allergic rhinitis, asthma, eczema, and/or a history of atopy.

Eosinophilic Esophagitis (click here to enlarge the image).

What causes the symptoms of EoE?

Remodeling of the esophagus is a hallmark of EoE. This remodeling leads to esophageal dysfunction and bolus impaction.

Differences between children and adults with EoE

In children, EoE seems to be primarily a food antigen–driven disease, whereas in adults, mainly aeroallergen sensitization has been observed.

Treatment of EoE

Treatment modalities for EoE include the 3Ds: Drugs, Diet, and Dilation.

The crucial question is whether adult and pediatric EoE are different phenotypes of one single entity or whether we are confronted with two different diseases. The debate is still ongoing.


Pediatric and adult eosinophilic esophagitis: similarities and differences. Allergy, 2012 (free full text).

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