Clinical Features of EoE and Overall Prevalence

This clinical discussion features gastroenterology experts reviewing the evolving management of EoE, focusing on clinical presentation, diagnostic challenges, and treatment approaches. The panel includes specialists from major academic medical centers discussing adult and pediatric perspectives on this increasingly recognized condition.

In adults, EoE primarily presents as dysphagia, where patients experience difficulty swallowing with food “slowing down” or not passing easily. A significant subset presents with acute food impaction requiring emergency intervention, though these patients typically have ignored earlier warning signs. Many patients unconsciously develop adaptive behaviors over years, including avoiding certain foods, cutting food into smaller pieces, chewing excessively, prolonging mealtimes, using liquids or sauces to aid swallowing, and modifying food textures. These compensatory mechanisms often mask the severity of symptoms, making diagnosis challenging as patients may deny swallowing difficulties when directly questioned.

Pediatric presentations vary by developmental stage. Younger children may exhibit feeding difficulties, food refusal, or reluctance to advance to age-appropriate textures, with parents often needing to encourage eating. Adolescents present similarly to adults with dysphagia and food impaction, but pill-swallowing difficulties serve as an important diagnostic clue. Children often report symptoms that parents are unaware of when questioned directly. Growth problems occur in approximately 16% of pediatric cases, though many children maintain adequate nutrition through adaptive eating strategies. The epidemiology of EoE shows rapidly increasing prevalence from 1 in 2000 fifteen years ago to current estimates of 1 in 700 or higher. This increase appears to outpace diagnostic awareness, suggesting environmental factors, early-life antibiotic or antacid exposure, and interactions with other atopic conditions may contribute to disease development beyond improved recognition alone.