Differences between childhood- and adulthood-onset eosinophilic esophagitis: An analysis from the EoE connect registry

Background: Direct comparisons of childhood-and adulthood-onset eosinophilic esophagitis (EoE) are scarce.Aim: To compare disease characteristics, endoscopic and histological features, allergic concomitances and therapeutic choices across ages.Methods: Cross-sectional analysis of the EoE CONNECT registry.Results: The adulthood-onset cohort (those diagnosed at >18y) comprised 1044 patients and the childhood-onset cohort (patients diagnosed at < 18 y), 254. Vomiting, nausea, chest and abdominal pain, weight loss, slow eating and food aversion were significantly more frequent in children; dysphagia, food bolus impaction and heartburn predominated in adults. A family history of EoE was present in 16% of pediatric and 8.2% of adult patients ( p < 0.001). Concomitant atopic diseases did not vary across ages. Median +/- IQR diagnostic delay (years) from symptom onset was higher in adults (2.7 +/- 6.1) than in chil-dren (1 +/- 2.1; p < 0.001). Esophageal strictures and rings predominated in adults ( p < 0.001), who under-went esophageal dilation more commonly ( p = 0.011). Inflammatory EoE phenotypes were more common in children ( p = 0.001), who also presented higher eosinophil counts in biopsies ( p = 0.015) and EREFS scores ( p = 0.017). Despite PPI predominating as initial therapy in all cohorts, dietary therapy and swal-lowed topical corticosteroids were more frequently prescribed in children ( p < 0.001).Conclusions: Childhood-onset EoE has differential characteristics compared with adulthood-onset, but similar response to treatment.(c) 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.