Eosinophilic esophagitis in children: new kids on the block

Introduction: Eosinophilic esophagitis (EoE) is an immune-mediated disease characterized by esophageal dysfunction and eosinophil rich inflammatory infiltrate. Its incidence is rising globally due to increased awareness, improved diagnostics, and environmental and genetic factors. EoE is driven by a Th2-mediated immune response to food and environmental allergens, leading to chronic inflammation, epithelial barrier dysfunction and progressive esophageal remodeling. Areas covered: This review explores pediatric EoE, focusing on epidemiology, pathogenesis, clinical presentation, diagnosis, and both standard and new treatment strategies. Symptoms vary by age, from feeding difficulties in infants to dysphagia and food impaction in older children. Diagnosis relies on clinical symptoms, endoscopic findings and histologic assessment. Standard treatments include dietary elimination, proton pump inhibitors and topical corticosteroids, while biologic therapies such as dupilumab offer targeted alternatives for refractory cases. Expert opinion: Future research focuses on optimizing treatment sequencing (step-up and step-down approach), exploring non-eosinophil-mediated inflammation, and enhancing noninvasive test to predict disease severity and phenotypes for better long-term management.