Supplementary Material for: Pediatric Eosinophilic Esophagitis: Challenges in Treatment and Long-Term Follow-Up

Background:
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease increasingly recognized in children. Despite growing awareness, diagnostic delays, heterogeneous presentations, and variable treatment responses continue to complicate management.
Objective:
This study aimed to describe the real-world clinical characteristics, atopic features, treatment patterns, and long-term outcomes of children with EoE, and to identify practical challenges that may inform more effective management strategies.
Methods:
This retrospective study included 50 children diagnosed with EoE between October 2020 and October 2025 at a tertiary pediatric center. Demographic, clinical, endoscopic, histopathological, and allergic data were reviewed. Symptom burden and adaptive behaviors were evaluated using the Gazi Eosinophilic Esophagitis Symptom and Adaptation Scale (GaziESAS).
Results:
Of the 50 patients, 33 (66%) were male. The median diagnosis age of 10.5 years with an estimated diagnostic delay of 1.6 years. At least one concomitant atopic disease was present in 36 patients (72%), most commonly allergic rhinitis in 24 (48%) and asthma in 16 (32%). Food sensitization was detected in 15 of 47 evaluated patients (31.9%), and patch test positivity in 15 of 49 patients (30.6%). All patients initially received proton pump inhibitors; topical corticosteroids and/or elimination diets were added as needed. Older age at diagnosis correlated with higher total GaziESAS scores (r = 0.524, p < 0.001), mainly due to adaptive behaviors (ρ = 0.457, p = 0.001). Females showed higher peak eosinophil counts than males (82.3 ± 37.3 vs. 49.6 ± 25 eos/HPF, p = 0.001). Complete histologic remission—defined as <15 eosinophils per high-power field in all follow-up endoscopies after the diagnostic procedure—was achieved in 25 patients (50%).