PedEoEvolution: optimizing pediatric and adolescent eosinophilic esophagitis management in Italy

This review addresses the unique challenges of pediatric eosinophilic esophagitis (EoE) management, aimingto develop a comprehensive knowledge base, standardize therapeutic approaches, and explore new targetedbiological treatments. A non-systematic literature review was conducted, complemented by two surveys: onefor clinicians to validate current practices and another for the President of the Italian Association of FamiliesAgainst Eosinophilic Esophagitis to assess disease burden. An expert panel discussed and validated the results.The study identified a prevalence of 32.9 per 100,000 in pediatric EoE in Italy, with only half of the cases accuratelydiagnosed and an average diagnostic delay of 18 months. Current treatments show limitations in long-termmanagement, with 27.8% of patients proving ineligible, intolerant, or inadequately controlled. The Impact Scoreand SCOPE (Symptoms, Comprehensive Observation, Pathological Evaluation) approach were recommended forearly diagnosis and treatment efficacy evaluation. Dupilumab emerged as a promising therapy for patients unresponsive to conventional treatments, demonstrating significantly higher rates of histological remission in children aged 1-11 years compared to placebo in clinical trials. This study provides a standardized approach to pediatric EoE management, emphasizing early diagnosis, multidisciplinary care, and targeted biological treatments. The findings highlight the need for increased awareness, standardized care pathways, and further research to address ongoing challenges in pediatric EoE management.