Ricerc@Sapienza

Eosinophilic esophagitis (EoE) is an emerging chronic immune and antigen-mediated
clinicopathologic disease. During the last 2 decades, the incidence of this condition in children has
increased significantly, thanks to practitioners for creating the awareness and higher use of diagnostic
endoscopy. We have analysed paediatric literature on EoE focusing on the epidemiology,
pathophysiology, clinical findings and diagnostic approach.
EoE is pathogenically related to a Th2 inflammation characterized by a mixed IgE and non-IgEmediated
reaction to food and/or environmental agents. This leads to esophageal dysfunction and
remodeling accompanied by subepithelial fibrosis. EoE can be presented with several range of gastrointestinal
symptoms, including regurgitation, vomiting, feeding difficulties or feeding refusal in
infants and toddlers, as well as heartburn, dysphagia and food bolus impaction in older children and
adults. The diagnostic suspicion is based on the presence of chronic symptoms of esophgeal dysfunction
and esophageal eosinophilia characterised histologically by a significant eosinophilic infiltration
of the oesophageal mucosa (>15 eosinophils per high powered field). In this review, we will
provide an update on clinical presentation and diagnostic approach to EoE in children. We emphasized
on the relevant aspects of the new clinical condition termed “PPI responsive esophageal
eosinophilia”, as entities distinct from EoE and the role of PPI trial in the diagnostic workup, therefore
we proposed a new diagnostic algorithm.