Eosinophilic esophagitis in pediatrics: advances in diagnosis, treatment, and follow-up.

OBJECTIVE

To identify the evidence and recommendations regarding pediatric eosinophilic esophagitis (EoE), including its diagnosis, treatment, and follow-up.

SOURCES: Narrative review based on a comprehensive and structured search of the MEDLINE (PubMed), EMBASE (Ovid), LILACS, and SciELO databases using the terms "diagnosis" OR "clinical manifestations" OR "treatment" OR "follow-up" AND "eosinophilic esophagitis" AND "children" through March 2026. Data obtained from the Brazilian Consensus (Brazilian Society of Pediatrics/Brazilian Association of Allergy and Immunology) were incorporated.

SUMMARY OF THE FINDINGS: EoE is a chronic and emerging disease, and a significant cause of esophageal dysfunction. Early and accurate diagnosis is fundamental to avoid complications, such as fibrostenotic sequelae. Treatment can be performed with proton pump inhibitors, topical corticosteroids, and empirical diets, chosen according to clinical profile, adherence, and socioeconomic context. In refractory cases, dupilumab is an effective option. Allergy tests should not guide elimination diets. Endoscopic follow-up with biopsies is essential for evaluating response and maintenance, as the relapse rate is high, even in asymptomatic patients. Reassessment intervals should be individualized, but post-induction control between 8 and 12 weeks and periodic reviews during maintenance are recommended.

CONCLUSIONS

The dissociation between symptoms and histological inflammation represents one of the greatest clinical challenges, in addition to the heterogeneity of therapeutic response and limitations of long-term studies. Changes in follow-up and treatment algorithms are expected, especially with the inclusion of dupilumab. The Brazilian consensus represents an attempt to standardize diagnostic criteria, approach, and treatment.