Pediatric and adult eosinophilic esophagitis: similarities and differences

<jats:title>Abstract</jats:title><jats:p>Early in the 1990s, several case series described adults suffering from dysphagia and children with refractory reflux symptoms, both accompanied by an eosinophil‐predominant infiltration, thereby conclusively distinguishing it from gastroesophageal reflux disease. Eosinophilic esophagitis (<jats:styled-content style="fixed-case">E</jats:styled-content>o<jats:styled-content style="fixed-case">E</jats:styled-content>) was recognized as its own entity in the adult and in the pediatric literature. In the last decade, evidence has accumulated that <jats:styled-content style="fixed-case">E</jats:styled-content>o<jats:styled-content style="fixed-case">E</jats:styled-content> represents a <jats:styled-content style="fixed-case">T</jats:styled-content>‐helper (<jats:styled-content style="fixed-case">T</jats:styled-content>h)2‐type inflammatory disease. Remodeling of the esophagus is a hallmark of <jats:styled-content style="fixed-case">E</jats:styled-content>o<jats:styled-content style="fixed-case">E</jats:styled-content>, leading to esophageal dysfunction and bolus impaction. Familial occurrence and disease association with single‐nucleotide polymorphisms underscore the influence of genetics in this disease. Eosinophilic esophagitis may affect individuals at any age, although the clinical presentation is highly age dependent. There is a significant allergic bias in the <jats:styled-content style="fixed-case">E</jats:styled-content>o<jats:styled-content style="fixed-case">E</jats:styled-content> population, with the majority of patients having concurrent allergic rhinitis, asthma, eczema, and/or a history of atopy. One noteworthy difference is that in children, <jats:styled-content style="fixed-case">E</jats:styled-content>o<jats:styled-content style="fixed-case">E</jats:styled-content> seems to be primarily a food antigen–driven disease, whereas in adults, mainly aeroallergen sensitization has been observed. Treatment modalities for <jats:styled-content style="fixed-case">E</jats:styled-content>o<jats:styled-content style="fixed-case">E</jats:styled-content> include the 3<jats:styled-content style="fixed-case">D</jats:styled-content>s: drugs, diet, and dilation. The crucial question of whether adult and pediatric <jats:styled-content style="fixed-case">E</jats:styled-content>o<jats:styled-content style="fixed-case">E</jats:styled-content> are different phenotypes of one single entity or whether we are confronted with two different diseases is still open. Here, we review similarities and differences between <jats:styled-content style="fixed-case">E</jats:styled-content>o<jats:styled-content style="fixed-case">E</jats:styled-content> in adults and children.</jats:p>