Eosinophilic esophagitis and clinical, endoscopic and therapeutic differences between adolescents and adults

Abstract

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory immune-mediated esophageal disease resulting from local exposure to ingested food or antigens. There are no studies in the field that directly compare the characteristics of adolescent-onset EoE and adult-onset EoE.

Aims: To compare the disease characteristics, diagnostic delay, endoscopic and histological features, allergic comorbidities, and therapeutic options between adolescent-onset EoE (12 to 17 years) and adult-onset EoE (≥18 years).

Patients and Methods: Patients were identified from the esophageal biopsy results of the past 5 years at 4 different institutions. Clinical, histological, endoscopic, and therapeutic data were collected after contacting the patients. Analyzed variables for statistical differences between the two groups included sex, age, diagnostic delay, disease phenotype, persistent allergic symptoms (rhinitis, conjunctivitis, asthma, dermatitis), endoscopic features measured using the EREFS score (edema, rings, exudates, furrows, strictures), eosinophil count per high-power field in esophageal biopsies at diagnosis, and choice of first-line treatment. Statistical significance was established at p<0.05.

Results: A total of 334 patients with histological diagnosis of EoE were identified. Among them, 272 were diagnosed in adulthood (81.4%) and 62 during adolescence (18.6%). There were no differences in gender distribution (196 adult males (72.1%) and 47 adolescent males (75.8%); p=0.66), nor in the presence of persistent allergic symptoms (p-values from 0.18 to 0.7). Diagnostic delay was significantly longer for adults than for adolescents (22 ± 6.4 months vs. 12 ± 2.9 months; p=0.001). A stricture phenotype predominated at diagnosis in adults (16.9% vs. 6.5%; p=0.02), with a higher dilation rate in adults compared to children (9.6% vs. 1.6%, p=0.038). In contrast, endoscopic findings suggestive of EoE were more frequent in adolescents than in adults (EREFS score: 95.2% vs. 90.1; p=0.036), and adolescents exhibited a higher peak eosinophil count in esophageal biopsies than adults (47 ± 15.7 vs. 35 ± 14.1; p=0.017). Finally, significant differences were also found in first-line therapies used to treat EoE between children and adults, with children more frequently treated with dietary restrictions (83.8% vs. 43.2%; p<0.01), oral topical corticosteroids (77.4% vs. 50.3%; p<0.01), while proton pump inhibitors were more commonly prescribed in adults (91.2% vs. 54.8%; p=0.038).

Conclusion: Adolescent- and adult-onset EoE have differential characteristics in terms of diagnostic delay, endoscopic and histologic features, and in endoscopic and pharmacologic therapeutic options. The factors that determine such differences warrant further study in the future.