Bridging eosinophilic esophagitis: healthcare transition from pediatric to adult patients

Eosinophilic esophagitis (EoE) is a chronic and progressive type 2 immune-mediated disease resulting in esophageal dysfunction. As with other chronic conditions, therapeutic continuity is crucial to ensure patient benefits, particularly during the transition of patients with EoE from pediatric to adult care. This investigation aimed to establish an algorithm to assist healthcare providers in optimizing the healthcare transition pathway through a multistep collaborative process that encompassed an initial analysis of the three principal currently available guidelines, the formulation of recommendations by a steering committee, and their validation through deliberation with a panel of 11 Italian EoE experts. Three essential criteria have been elucidated to define the healthcare transition pathway for pediatric patients with EoE to adulthood: readiness to transition, patient’s age, and disease control (from clinical, endoscopic, and histological perspectives). The algorithm incorporates the utilization of the STARx questionnaire as an efficacious instrument to assess patient’s readiness to transition, identifies the optimal age for this phase within the range of 14–18 years, and considers clinical, endoscopic, and histological control maintained for a minimum of 6 months. The availability of a standardized and well-defined pathway supporting healthcare professionals during the transition process of pediatric EoE patients to adulthood is associated with therapeutic continuity, enhancement of clinical outcomes, and prevention of long-term fibrostenotic complications, which may result in economic benefits for the Italian health system.