Differences between childhood- and adulthood-onset eosinophilic esophagitis: An analysis from the EoE connect registry
Emilio José Laserna-Mendieta 1 , Pilar Navarro 2 , Sergio Casabona-Francés 3 , Edoardo V Savarino 4 , Isabel Pérez-Martínez 5 , Danila Guagnozzi 6 , Jesús Barrio 7 , Antonia Perello 8 , Antonio Guardiola-Arévalo 9 , María Elena Betoré-Glaria 10 , Leonardo Blas-Jhon 11 , Francesca Racca 12 , Anne Lund Krarup 13 , Carolina Gutiérrez-Junquera 14 , Sonia Fernández-Fernández 15 , Susana De la Riva 16 , Juan E Naves 17 , Silvia Carrión 18 , Natalia García-Morales 19 , Valentín Roales 20 , Juan Armando Rodríguez-Oballe 21 , Raffaella Dainese 22 , Alba Rodríguez-Sánchez 23 , María Lluisa Masiques-Mas 24 , Sara Feo-Ortega 25 , Matteo Ghisa 4 , Daria Maniero 4 , Adolfo Suarez 5 , Ronald Llerena-Castro 26 , Paula Gil-Simón 27 , Luisa de la Peña-Negro 28 , Alicia Granja-Navacerrada 29 , Javier Alcedo 10 , Lonore Hurtado de Mendoza-Guena 11 , Gaia Pellegatta 30 , María Teresa Pérez-Fernández 3 , Cecilio Santander 31 , Sonsoles Tamarit-Sebastián 32 , Ángel Arias 33 , Alfredo J Lucendo 34 , EUREOS EoE CONNECT Research group
Background: Direct comparisons of childhood- and adulthood-onset eosinophilic esophagitis (EoE) are scarce.
Aim: To compare disease characteristics, endoscopic and histological features, allergic concomitances and therapeutic choices across ages.
Methods: Cross-sectional analysis of the EoE CONNECT registry.
Results: The adulthood-onset cohort (those diagnosed at ≥18y) comprised 1044 patients and the childhood-onset cohort (patients diagnosed at <18 y), 254. Vomiting, nausea, chest and abdominal pain, weight loss, slow eating and food aversion were significantly more frequent in children; dysphagia, food bolus impaction and heartburn predominated in adults. A family history of EoE was present in 16% of pediatric and 8.2% of adult patients (p<0.001). Concomitant atopic diseases did not vary across ages. Median±IQR diagnostic delay (years) from symptom onset was higher in adults (2.7 ± 6.1) than in children (1 ± 2.1; p<0.001). Esophageal strictures and rings predominated in adults (p<0.001), who underwent esophageal dilation more commonly (p = 0.011). Inflammatory EoE phenotypes were more common in children (p = 0.001), who also presented higher eosinophil counts in biopsies (p = 0.015) and EREFS scores (p = 0.017). Despite PPI predominating as initial therapy in all cohorts, dietary therapy and swallowed topical corticosteroids were more frequently prescribed in children (p<0.001).
Conclusions: Childhood-onset EoE has differential characteristics compared with adulthood-onset, but similar response to treatment.
CITATION Dig Liver Dis. 2023 Mar;55(3):350-359. doi: 10.1016/j.dld.2022.09.020. Epub 2022 Oct 22