Advanced Practice Provider EoE Program (Live/Virtual) | October 2025-Adolescent Case Studies and Debates

Adolescent Case Studies and Debates

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This presentation by Puanani Hopson, MS, DO from Mayo Clinic reviews adolescent eosinophilic esophagitis (EoE) through case studies focusing on clinical presentation, diagnosis, and management. EoE commonly affects males (~3:1 ratio) and symptoms vary by age, often nonspecific in younger children (feeding disorders, vomiting, abdominal pain) but more classical in adolescents (dysphagia, food impaction, heartburn). It often overlaps with GERD, complicating diagnosis and treatment. Untreated EoE may progress from inflammation to fibrosis, increasing risk for strictures.<br /><br />Diagnosis relies primarily on endoscopy with visual assessment (EREFS scoring exudates, rings, edema, furrows, strictures) and histology (≥15 eosinophils/high power field). Ancillary tests include esophagrams, pH monitoring, allergy testing, and nutritional assessments.<br /><br />Three adolescent cases illustrate clinical dilemmas:<br /><br />1. A 17-year-old female with dysphagia, heartburn, and atopic disease showed high eosinophil counts and EREFS 5. Dupilumab improved symptoms and reduced eosinophilia, but Barrett’s changes and GERD required ongoing high-dose PPI therapy, highlighting the importance of evaluating GERD overlap.<br /><br />2. A 16-year-old male with intermittent vomiting and food allergy history developed food impaction. Treatment with swallowed budesonide improved eosinophilia, but persistent fibrosis noted by EoE histology score raised questions about ongoing strictures, esophageal hypersensitivity, or medication adherence. Fibrosis detection methods and possible dilation were discussed.<br /><br />3. A 12-year-old male with heartburn and weight loss was diagnosed with ARFID secondary to EoE after endoscopy showed elevated eosinophils. Despite initial PPI, symptoms persisted and budesonide plus famotidine improved clinical and histological status, underscoring individualized treatment and the possibility of coexisting functional disorders.<br /><br />Key takeaways include the heterogeneity of pediatric EoE symptoms, necessity of endoscopic and histologic monitoring to guide therapy, distinction from or coexistence with GERD, and need for personalized management plans with shared decision-making. Early diagnosis and treatment are essential to prevent fibrosis and complications.

Keywords

eosinophilic esophagitis

adolescent EoE

clinical presentation

diagnosis

management

GERD overlap

endoscopy

histology

dupilumab

budesonide