CLINICAL PRESENTATION OF EOSINOPHILIC ESOPHAGITIS IN CHILDREN: A PUZZLING STORY

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by eosinophilic infiltration of the esophageal epithelium with esophageal dysfunction symptoms. In pediatric patients, clinical manifestations vary depending on age onset, from a gastroesophageal reflux disease (GERD)-like condition to severe dysphagic symptoms. Infants and toddlers may present with vague and/or ambiguous symptoms including feeding difficulties, food refusal and gagging or GERD-like symptoms, whereas in school aged children and adolescents prevalent symptoms include dysphagia and food impaction. The major histological diagnostic criterion is the finding of a peak number of ≥15 eosinophils/high powered field (hpf) in biopsy specimens obtained from several areas of the esophagus, in upper endoscopy. The Pediatric Eosinophilic Esophagitis Symptom Score (PEESS® v2.0) questionnaire and the Pediatric Quality of Life Inventory (PedsQL) questionnaire are valid and reliable tools for assessing the severity of clinical symptoms at diagnosis, for disease monitoring and assessment of the response to treatment as well as for long tem follow up of pediatric patients with EoE. The goal of EoE therapy is to achieve clinical and histological remission, to prevent esophageal fibrosis, to promote normal growth and development and improve patients' quality of life.