Clinical Presentation of Eosinophilic Esophagitis in Children: A Puzzling Story.

BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterized by eosinophilic infiltration of the esophageal epithelium and symptoms of esophageal dysfunction. In pediatric patients, clinical presentation varies with age, ranging from gastroesophageal reflux disease-like symptoms in infants and toddlers to dysphagia and food impaction in older children and adolescents. SUMMARY: Diagnosis is based on peak histological evidence of ≥15 eosinophils per high-power field in esophageal biopsy specimens obtained during upper endoscopy. Clinical assessment and follow-up are supported by validated tools, including the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS® v2.0) and the Pediatric Quality of Life Inventory (PedsQL™). These instruments enable evaluation of symptom severity, monitoring of disease course, and assessment of treatment response. KEY MESSAGES: Pediatric EoE presents with age-dependent clinical features. Histological confirmation (≥15 eosinophils/hpf) is required for diagnosis. PEESS® v2.0 and PedsQL™ are reliable tools for clinical assessment and follow-up. Treatment aims to achieve clinical and histological remission, prevent fibrosis, and improve growth and quality of life.