Pediatric eosinophilic esophagitis: survey of gastroenterologists from Latin America and Spain.

Abstract

Background: Eosinophilic esophagitis (EoE) is an immuno-allergic disease characterized by esophageal dysfunction and eosinophilic infiltration of the esophagus. Its prevalence has increased, making it the leading cause of dysphagia and food impaction in children and adolescents. Understanding the approach taken by pediatric gastroenterologists in different regions is crucial.

Method: Multicenter and cross-sectional observational study, carried out through a virtual questionnaire during 2022, answered voluntarily and anonymously. Percentage descriptive statistics were performed.

Results: 118 responses were obtained. Approximately 3% of physicians diagnose up to two cases of eosinophilic esophagitis per year. About 55.9% performed 3-4 biopsies in the upper and lower thirds of the esophagus for diagnosis. Initial treatments in patients without stenosis: proton pump inhibitors (PPI) 33.9%, triple therapy (TT) (PPI + diet + topical corticosteroids [TCSs]) 26.27%, and combined (diet + PPI) 21%. Patients with stenosis: TT 52.58%, combined (TCSs + PPI) 13.4%. Initial dietary treatment: according to allergy tests 26.2%, empirical exclusion of 6-8 foods 25.4%, and 2-4 foods 23.7%. The first endoscopic control is performed at 8 and 12 weeks in 46.6% and 38%, respectively. 52% referred to an allergist and 47.4% to nutrition. About 48.3% do not monitor basal cortisol in corticosteroid treatment for more than 3 months.

Conclusion: The diagnostic and therapeutic approach in EoE is heterogeneous. Dietary treatment shows the exclusion of a large number of foods and monitoring the prolonged use of corticosteroids is not a common practice.