Recognizing EoE Across Pediatric and Adult Patients

Welcome back to another HCPLive Peer Exchange series. In this episode titled, “Recognizing EoE Across Pediatric and Adult Patients,” expert faculty examine the symptoms, eating behaviors, and comorbidities that can raise suspicion for eosinophilic esophagitis (EoE) and discuss how clinical presentation can differ by age.

The panel highlights dysphagia as a hallmark symptom of EoE in adults while emphasizing that patients may not describe swallowing difficulty directly. Instead, clinicians may uncover adaptive eating behaviors, such as cutting food into small pieces, avoiding certain textures, using liquids to help food pass, or having difficulty swallowing pills. In pediatric patients, EoE may present differently, with abdominal pain, failure to thrive, nutritional deficiencies, food refusal, or texture preferences. The panel also discusses the importance of assessing for associated type 2 inflammatory conditions, including food allergies, atopic dermatitis, asthma, and allergic rhinitis.

As recognition of EoE has increased, the panelists describe adopting a more proactive approach to patients with dysphagia or GERD-like symptoms, including maintaining a high index of suspicion and considering earlier endoscopic evaluation with biopsy. They also examine food impaction as an important presentation of EoE and explain why a detailed history can uncover previous episodes of food sticking that patients may have normalized. The discussion concludes by emphasizing the importance of obtaining biopsies during endoscopy for food impaction when appropriate, helping establish an EoE diagnosis while reducing the potential for patients to be lost to follow-up.

The next episode in this series, ‘Establishing a Confident EoE Diagnosis,’ features the panelists discussing when suspected EoE warrants endoscopic evaluation and biopsy and the clinical, histologic, and endoscopic findings needed to support an accurate diagnosis. The panel also explores differentiating EoE from other causes of esophageal eosinophilia and the importance of collaboration across the care team.