Esophageal Eosinophilia in Pediatric and Young Adult Patients with Inflammatory Bowel Disease: Diagnosis, Clinical Course, and Treatment Outcomes

Background/Objectives: This study evaluates the clinical presentation and treatment outcomes of esophageal eosinophilia (EE) in patients with inflammatory bowel disease (IBD). It compares outcomes based on the timing of diagnosis (simultaneous vs. EE after IBD diagnosis) and treatment (treated vs. untreated EE). Methods: This retrospective cohort study included patients ≤ 22 years with IBD and EE (≥15 eosinophils/high-powered field {eos/HPF}) between July 2017 and December 2023. Clinical, endoscopic, histologic, and EE treatment data were collected. EE histologic remission defined as <15 eos/HPF was assessed on repeat esophagogastroduodenoscopy (EGD). Groups were compared using standard statistical tests, with p < 0.05 considered significant. Results: Of fifty-six patients with IBD and EE, thirteen (23%) were diagnosed with EE and IBD simultaneously and forty-three (77%) patients were diagnosed with EE after IBD. Most were diagnosed with EE incidentally. Esophageal symptoms and histologic findings between patients diagnosed simultaneously vs. EE after IBD were similar. Among patients treated for EE (n = 28) and those who were untreated (n = 28), there were significant differences in esophageal symptoms (54% vs. 0%; p < 0.01) and median esophageal eosinophil count (30 vs. 22 eos/HPF; p = 0.003). However, among patients with a repeat EGD, EE histologic remission rates were similar between those who were treated vs. untreated (35% vs. 47%; p = 0.5). Conclusions: We found that for patients with both IBD and EE, most were diagnosed incidentally with EE after IBD diagnosis. The observation of spontaneous histologic esophageal remission in a subset of patients suggests that incidental EE in patients with IBD may not always represent eosinophilic esophagitis (EoE) and should not automatically lead to a lifelong diagnosis.