Factors associated with treatment response in eosinophilic esophagitis patients: Experience from a pediatric tertiary care center.

Abstract

Background: Eosinophilic esophagitis (EoE) is a disease characterized by eosinophilic inflammation of the esophagus and associated esophageal dysfunction with increasing worldwide prevalence. Clinical presentation is nonspecific and varies with age, with limited studies in the pediatric population. Objective: Our study aimed to compile clinical phenotypes, esophagogastroduodenoscopy findings, and treatment response of EoE in a tertiary pediatric center, and to examine factors associated with the response of treatment. Methods: In this retrospective study, we reviewed the medical records of 824 patients diagnosed with EoE at Children's Hospital of Michigan from 2011 to 2021. Data collected included a demographic profile, symptoms, esophagogastroduodenoscopic and histopathologic findings, treatment modalities, response, and compliance. We then performed a multivariable logistic regression to assess the associating factors that influenced the treatment response rate. Results: A high proportion of males and coexisting allergic conditions were observed in the patients with EoE, with the most common presentation of vomiting in children and of abdominal pain in adolescents. Among 656 of the 824 patients who had follow-up esophagogastroduodenoscopy, treatment response rates varied among modalities, with proton-pump inhibitor treatment exhibiting the highest response rate, at 60.8%, followed by diet modification (50%) and topical steroid treatment (43.5%). Significant predictors of normal endoscopic findings at follow-up included female gender, normal endoscopic appearance, good compliance to treatment, and absence of topical steroids in the treatment regimen. There were no significant differences in outcomes observed for targeted elimination led by a skin-prick test or specific immunoglobulin E test. Medication compliance did not significantly differ among the treatment options. Conclusion: Managing EoE in pediatric patients poses significant challenges, which emphasizes the need for multidisciplinary care to achieve treatment response effectively. The findings underscore the complexity of managing EoE and the need for individualized treatment approaches. Further research is warranted to elucidate the underlying mechanisms and optimize management strategies for pediatric patients with EoE.