Differences Between Childhood- and Adulthood-onset Eosinophilic Esophagitis: An Analysis from the EoE Connect Registry

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.