Eosinophilic Esophagitis: Aerodigestive Disease Perspective

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TA Temtem, K Liu, KL Kennedy, BD Gold. Pediatr Gastroenterol Nutr. 2026; Online ahead of print. Eosinophilic esophagitis: An aerodigestive perspective

This review article highlights the management and high frequency of eosinophilic esophagitis in children with complex aerodigestive disease disorders. Congratulations to my colleague Dr. Benjamin Gold, one of the contributors, and our aerodigestive disease team for this publication.

Key points:

  • “Special populations such as esophageal atresia/tracheoesophageal fistula and those patients requiring laryngotracheal reconstruction (LTR) should undergo esophagogastroduodenoscopy with biopsies to evaluate for EoE, even in absence of typical symptoms”
  • “The prevalence of EoE in aerodigestive patients ranges from 3.7% to 25% (Table 1).”
  • “The clinical presentation of EoE can range from typical symptoms of feeding difficulty to atypical presentations of chronic cough, recurrent croup, hoarseness, or inflammatory consequences found at the time of airway evaluation.3, 4, 12“
  • Delays in the diagnosis of EoE for 6 years or more are common. “Studies demonstrate…a 9% increased risk of stricture for each additional year of undiagnosed EoE.”
  • “Patients undergoing LTR are also managed by aerodigestive teams and should have screening esophagogastroduodenoscopy (EGD) prior to surgery, as untreated EoE can result in graft failure.10“
  • “Management of aerodigestive patients with EoE is similar to the general population…A limitation of topical steroids is that oral is the only route of administration.”

Critique:

  • The authors note that “in a review of 251 EoE patients, 14% of the patients who were initially evaluated by otolaryngology presented with isolated airway complaints and an absence of GI symptoms.14” However, in my experience, many ENT physicians are not asking questions like ‘how long does it take your child to eat? or ‘does your child need to drink a lot of fluid to help them swallow?’
  • The authors conclude that “it is imperative for the aerodigestive clinician to recognize the range of EoE presentations and thus, with a higher index of suspicion, reduce diagnostic delay. EA/TEF patients are at high risk of EoE and should undergo routine surveillance EGD, even in the absence of symptoms.” In my experience, the threshold for arranging a triple endoscopy is quite low for the aerodigestive team. This messaging​, though, is important for patients seen outside the aerodigestive clinic.
  • There is no discussion of cost and redundancy in this article. Many aerodigestive patients, prior to going to the multispecialty clinics, already have GI, pulmonary and/or ENT physicians. Communication among their specialists could obviate the need for aerodigestive evaluation in many patients.

My take: This article provides a useful review of EoE in the aerodigestive disease population and highlights how respiratory symptoms can be the main clinical presentation.

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