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Pediatric Eosinophilic Esophagitis (Biologic Therapies)

Eosinophilic esophagitis in children is a chronic Th2-mediated inflammatory disease; biologic agents like dupilumab are FDA-approved for refractory cases.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Çocuk Sağlığı ve Hastalıkları department. Book Appointment →

What is Pediatric Eosinophilic Esophagitis (Biologic Therapies)?

Pediatric eosinophilic esophagitis (EoE) is a chronic Th2-mediated inflammatory disease characterized by isolated esophageal eosinophilic infiltration. Prevalence is 1/2000 in children and increasing. Atopic background (asthma, allergic rhinitis, food allergy) in 70%.

Pathogenesis: food and aerosol antigens → Th2 activation → IL-4, IL-5, IL-13 increase → eotaxin-3 (CCL26) → eosinophil recruitment → tissue remodeling and fibrosis. Long-term: esophageal stricture, food impaction.

Diagnosis: dysphagia, food impaction, vomiting → endoscopy (rings, furrows, exudate, EREFS score) + biopsy (>15 eosinophils/HPF, ≥6 sites). Treatment ladder: 1) PPI 8-12 weeks, 2) topical steroids (swallowed budesonide, fluticasone), 3) elimination diet (6FED, milk-soy-egg-wheat-nuts-seafood), 4) dupilumab (anti-IL-4Rα, FDA 2022 for ≥12 years), 5) endoscopic dilation (stricture). Real-life: dupilumab 89% histological response.

Symptoms

Dysphagia (especially solid foods)
Food impaction (sudden urgent presentation)
Persistent vomiting
Chest pain, retrosternal burning
Heartburn (PPI-resistant)
Failure to thrive (in young children)

Risk Factors

Atopy (asthma, allergic rhinitis, food allergy)
Family history of EoE
Male gender (3:1)
Caucasian race
Cesarean delivery, lack of breastfeeding
Antibiotic exposure (early childhood)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent dysphagia
  • Food impaction (urgent)
  • Persistent reflux + atopy
  • PPI-resistant heartburn
  • Failure to thrive + atopy history
  • Dysphagia + chest pain

Treatment Methods

01
PPI 1-2 mg/kg BID 8-12 weeks (first step)
02
Swallowed budesonide 0.5-2 mg/day
03
Empiric 6-food elimination diet
04
Dupilumab 200-300 mg/2 weeks SC (≥12 years)
05
Endoscopic dilation (stricture)
06
Annual endoscopic follow-up + biopsy

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Çocuk Sağlığı ve Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.