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Pediatric Eosinophilic Esophagitis

Results of the European Retrospective Pediatric Eosinophilic Esophagitis Registry (RetroPEER)

Hoofien, Assaf*; Dias, Jorge A.; Malamisura, Monica; Rea, Francesca§; Chong, Sonny||; Oudshoorn, Johanna; Nijenhuis-Hendriks, Danielle#; Otte, Sebastian**; Papadopoulou, Alexandra††; Romano, Claudio‡‡; Gottrand, Frederic§§; Miravet, Victor V.||||; Orel, Rok¶¶; Oliva, Salvatore##; Junquera, Carolina G.***; Załęski, Andrzej†††; Urbonas, Vaidotas‡‡‡; Garcia-Puig, Roger§§§; Gomez, Maria J.M.||||||; Dominguez-Ortega, Gloria||||||; Auth, Marcus K.-H.¶¶¶; Kori, Michal###; Ben Tov, Amir****,††††; Kalach, Nicolas‡‡‡‡; Velde, Saskia V.§§§§; Furman, Mark||||||||; Miele, Erasmo¶¶¶¶; Marderfeld, Luba*,####; Roma, Eleftheria*****; Zevit, Noam*,††††

Journal of Pediatric Gastroenterology and Nutrition: April 2019 - Volume 68 - Issue 4 - p 552–558
doi: 10.1097/MPG.0000000000002215
Original Articles: Gastroenterology: Eosinophilic Gastrointestinal Diseases

Objectives: Recommendations for diagnosing and treating eosinophilic esophagitis (EoE) are evolving; however, information on real world clinical practice is lacking. To assess the practices of pediatric gastroenterologists diagnosing and treating EoE and to identify the triggering allergens in European children.

Methods: Retrospective anonymized data were collected from 26 European pediatric gastroenterology centers in 13 countries. Inclusion criteria were: Patients diagnosis with EoE, completed investigations prescribed by the treating physician, and were on stable medical or dietary interventions.

Results: In total, 410 patients diagnosed between December 1999 and June 2016 were analyzed, 76.3% boys. The time from symptoms to diagnosis was 12 ± 33.5 months and age at diagnosis was 8.9 ± 4.75 years. The most frequent indications for endoscopy were: dysphagia (38%), gastroesophageal reflux (31.2%), bolus impaction (24.4%), and failure to thrive (10.5%). Approximately 70.3% had failed proton pump inhibitor treatment. The foods found to be causative of EoE by elimination and rechallenge were milk (42%), egg (21.5%), wheat/gluten (10.9%), and peanut (9.9%). Elimination diets were used exclusively in 154 of 410 (37.5%), topical steroids without elimination diets in 52 of 410 (12.6%), both diet and steroids in 183 of 410 (44.6%), systemic steroids in 22 of 410 (5.3%), and esophageal dilation in 7 of 410 (1.7%). Patient refusal, shortage of endoscopy time, and reluctance to perform multiple endoscopies per patient were noted as factors justifying deviation from guidelines.

Conclusions: In this “real world” pediatric European cohort, milk and egg were the most common allergens triggering EoE. Although high-dose proton pump inhibitor trials have increased, attempted PPI treatment is not universal.

*Institute of Gastroenterology, Nutrition, and Liver Disease, Schneider Children's Medical Center of Israel, Petah Tikva, Israel

Pediatric Gastroenterology Unit, Centro Hospitalar São João, Porto, Portugal

Universitary Pediatric Department (DPUO) in Bambino Gesù Children's Hospital, IRCCS, University of Rome “Tor Vergata”

§Bambino Gesù Children's Hospital, Sant’Onofrio Square, 4, Rome, Italy

||Queen Mary's Hospital for Children, Epsom and St Helier University NHS Trust, Carshalton, United Kingdom

Gelre Hospitals, Pediatrics, Apeldoorn, The Netherlands

#Pediatrics Department, Juliana Children's Hospital, The Hague, The Netherlands

**Dr Von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany

††Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's Hospital ‘agia Sofia’, Athens, Greece

‡‡Pediatrics Department, University of Messina, Messina, Italy

§§Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, and Reference Center for Congenital and Malformative Esophageal Diseases, CHU Lille, University Lille, Lille, France

||||Pediatric Gastroenterology Unit, Hospital Sant Joan de Déu, Barcelona. Spain

¶¶Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia

##Department of Pediatrics, Sapienza - University of Rome, Rome, Italy

***Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain

†††Department of Pediatric Gastroenterology and Nutrition, Paediatrics with Clinical Assessment Unit, Warsaw Medical University, Warsaw, Poland

‡‡‡Vilnius University Clinic for Children's Diseases, Vilnius, Lithuania

§§§Hospital Universitari MútuaTerrassa, Terrassa, Spain

||||||Gastroenterology and Nutrition Department, Niño Jesús University Children Hospital, Madrid, Spain

¶¶¶Department of Paediatric Gastroenterology, Hepatology and Nutrition (GHN), Alder Hey Children's NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom

###Kaplan Medical Center, Rehovot, Israel

****Gastroenterology Unit, Dana-Dewk Children's Hospital, Tel Aviv Sourasky Medical Center

††††Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

‡‡‡‡St Vincent de Paul Hospital, Lille, France

§§§§Pediatric Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium

||||||||Royal Free Hospital, London, United Kingdom

¶¶¶¶Department of Translational Medical Science, Section of Paediatrics, University of Naples “Federico II”, Naples, Italy

####Nutrition and Dietetics Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel

*****First Department of Pediatrics and Mitera Children's Hospital, University of Athens School of Medicine, Athens, Greece.

Address correspondence and reprint requests to Noam Zevit, MD, Institute of Gastroenterology, Nutrition, and Liver Disease, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petah-Tikva 4920235, Israel (e-mail:;AssafHoofien,MD,SchneiderChildren'sMedicalCenterofIsrael,Petah-Tikva,Israel(

Received 15 August, 2018

Accepted 22 October, 2018

This study was supported by a networking research grant from the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

N.Z. reports consultant fees from Adare Pharmaceuticals. The remaining authors report no conflicts of interests.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,