Background:

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal condition triggered by exposure to food antigens. Its incidence is increasing, but the differences in its manifestations between adolescents and adults remain underexplored.

Objective:

This study aims to compare clinical characteristics, diagnostic delays, endoscopic and histological findings, allergic comorbidities, and therapeutic options in patients with EoE onset during adolescence (12-17 years) versus adulthood (≥18 years).

Materials and Methods:

A total of 334 patients diagnosed with EoE through esophageal biopsies across four institutions over five years were included. Data collected included variables such as sex, age, diagnostic delay, disease phenotype, presence of persistent allergic symptoms, endoscopic characteristics assessed using the EREFS score, and eosinophil counts in biopsies. Statistical analysis was performed to identify significant differences between the groups, with a significance threshold of p < 0.05.

Results:

Of the 334 patients, 272 were adults (81.4%) and 62 were adolescents (18.6%). No significant differences were found in sex distribution or allergic symptoms. However, adults experienced a longer diagnostic delay (22 months vs. 12 months, p = 0.001) and a higher prevalence of a stenotic phenotype (16.9% vs. 6.5%, p = 0.02). In contrast, adolescents exhibited a higher frequency of endoscopic findings indicative of EoE (EREFS: 95.2% vs. 90.1%; p = 0.036) and higher eosinophil counts (47 vs. 35 Eo/HPF [high power field], p = 0.017). Therapeutic approaches also differed: adolescents were predominantly treated with dietary restrictions and topical corticosteroids, while adults received proton pump inhibitors.

Conclusions:

EoE demonstrates differences in diagnosis, presentation, and treatment depending on the age of onset. These disparities highlight the need to develop age-specific management guidelines and to encourage further research into the factors driving these variations.

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