Distinct features in the clinical presentations of eosinophilic esophagitis in children and adults: is this the same disease?

Recent consensus guidelines define eosinophilic esophagitis (EoE) as a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Adults with EoE typically present with dysphagia, food impaction and reflux symptoms, while children primarily present with refractory reflux, abdominal pain, vomiting and growth failure. Endoscopic features are also somewhat different in adults and children. Adult patients often present with fibrostenotic features of EoE including rings, strictures and narrow-caliber esophagus, while children present with inflammatory features of EoE including edema, white exudates and furrowing. Despite these differences in symptom and endoscopic presentation, many similarities exist between the two groups suggesting that this is the same disease in both children and adults. First, atopic history and genetic predisposition have been demonstrated in both groups. Most convincing is that both adults and children respond to food allergen avoidance, implicating a common etiology in the pathogenesis of this disease. While additional data is needed to better understand the natural history of EoE, preliminary data suggests that EoE is the same disease in adults and children, but with different phenotypic presentations.