Australian novel findings shed light on difference between child and adult onset EoE

19 Aug 2021

Gastroenterologists in South Australia have been able to tease out the differences between childhood onset Eosinophilic oesophagitis (EoE) and adult onset disease in findings that may help clinicians diagnose the chronic condition earlier.

Investigators say the immune-mediated disease is increasingly being encountered in clinical practice but little is known about the natural history of the condition – particularly the differences in disease characteristics and progression of childhood-onset and adult-onset EoE.

The team, led by Associate Professor Nam Nguyen from the Department of Gastroenterology and Hepatology at Royal Adelaide Hospital, carried out a cross-sectional, questionnaire-based study, on 87 adults and 67 children from two major  hospitals in South Australia.

Most patients in both groups recalled experiencing symptoms for years prior to the diagnosis of EoE – a finding consistent with previous research where patients often described a history of symptoms that began years prior to their diagnosis.

The median duration of symptoms prior to diagnosis of EoE in the current study was >1-4 years in childhood-onset disease (44%) and ≥10 years in adult-onset disease (34%). Food impaction was significantly more common on initial presentation in those with adult-onset EoE whereas weight loss was more common in childhood-onset EoE.

At the time of questionnaire, regurgitation, abdominal pain, and bloating were more common in childhood-onset EoE. Those with childhood-onset EoE were more likely to have multiple symptoms when compared to their adult-onset counterparts.

According to investigators, those with childhood-onset EoE experienced more GORD and inflammatory-type symptoms, but there was no difference in the presence of continued symptoms into adulthood.

In adult-onset EoE, asthma was more common and a significantly higher rate of patients presented with food impaction compared to those with childhood-onset EoE. But this significance receded in the transition from childhood to adulthood, and dysphagia to solids ultimately became the most common symptom in both groups.

The researchers said their finding supported the theory that EoE progresses from an inflammatory to a fibrostenotic condition driven by the development of subepithelial fibrosis in the oesophagus.

Despite this trend, those with childhood-onset EoE continued to have a significantly higher incidence of multiple and inflammatory-type symptoms post transition into adulthood, particularly regurgitation, abdominal pain and bloating.

The novel discovery led the researchers to speculate that although fibrosis eventually develops in childhood-onset EoE, the inflammatory component remains significant enough to contribute to ongoing symptoms.

And with only 15% of both childhood-onset and adult-onset cohorts reporting being asymptomatic at the time of the questionnaire, the study suggests that most patients with childhood-onset EoE will continue to have symptoms and reduced quality of life into adulthood.

“We believe that our data adds impact to the theory that childhood-EoE is a progressive condition and not a different disease entity in children and adults,” they concluded.

The study was published in the Journal of Gastroenterology and Hepatology.

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