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Diagnostic challenges and variable presentations can lead to underestimation, and confirmation depends on histopathology from gastroscopy biopsies (≥15 eosinophils per high-power field). Dietary elimination may minimize systemic effects but can threaten nutrition, trigger feeding disorders, increase financial and social burdens, and require repeated endoscopic assessment, adding to patient disease burden. This narrative review summarizes these challenges in reference to current research and daily practice.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/challenges-in-dietary-therapy-in-pediatric-eosinophilic-esophagitis-eoe-a-narrative-review/467375/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/challenges-in-dietary-therapy-in-pediatric-eosinophilic-esophagitis-eoe-a-narrative-review/467375.png","ImageObject",300,407,{"name":92,"@type":93},"A glass of water","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the recommended diagnostic basis for pediatric EoE?","Question",{"text":112,"@type":113},"Diagnosis requires clinicopathologic assessment and exclusion of other causes of esophageal eosinophilic inflammation. It relies on histopathology from gastroscopy biopsies with a peak eosinophil count of at least 15 eosinophils per high-power field.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why can EGD appearance be insufficient for confirming EoE?",{"text":117,"@type":113},"Up to one-third of children may have a macroscopically normal-appearing esophagus. Even when inflammatory features exist, they can be subtle, so endoscopic appearance alone cannot confirm or exclude the diagnosis.",{"name":119,"@type":110,"acceptedAnswer":120},"What challenges are associated with dietary therapy in children with EoE?",{"text":121,"@type":113},"Elimination diets can target triggering factors and have limited systemic side effects when supervised, but the number of eliminated allergens may compromise quality of life. 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Stochel-Gaudyn *, A. Kozioł-Kozakowska  and K. Kowalska-Duplaga   \nAcademic Editor: Lutz Schomburg  \nReceived: 2 December 2025  \nRevised: 17 December 2025  \nAccepted: 24 December 2025  \nPublished: 26 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nDepartment of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, 31-008 Cracow, Poland; [agnieszka.koziol-kozakowska@uj.edu.pl](agnieszka.koziol-kozakowska@uj.edu.pl) (A.K.-K.);  \n[kinga.kowalska-duplaga@uj.edu.pl](kinga.kowalska-duplaga@uj.edu.pl) (K.K.-D.)  \n* Correspondence: [a.stochel-gaudyn@uj.edu.pl](a.stochel-gaudyn@uj.edu.pl)  \nAbstract  \nEosinophilic esophagitis (EoE) is a chronic, allergic, immune-mediated inflammation of the esophagus caused by food antigens. The prevalence in pediatric population is approximately 34 to 57 cases per 100,000 children, with a male to female ration 3:1 . This number may be underestimated due to diagnostic challenges and variety of clinical presentations indifferent age groups. Diagnosis of EoE requires histopathological assessment of esophageal biopsies retrieved during gastroscopy, with at least 15 eosinophils per high-power field (HPF) in the esophageal tissue being the cut off value. According to recommendations, treatment options of EoE include dietary interventions (elimination diets), medical treatment (inhibitors of proton pump, steroids, biologics), and in some cases surgical intervention (dilation) . Dietary intervention, such as elimination diets, target the triggering factors of the disease and, if supervised by professional nutritionist, have the least systemic side effects. On the other hand, depending on the number of allergens eliminated from the pediatric patients’ diet, the quality of life both of the child and their caretakers may be compromised. Additional challenges such as nutritional risks, feeding disorders, financial burden, and social life impairment also have to be taken into consideration. On top of this, an effectiveness assessment of chosen therapy requires repeated endoscopic examination with several biopsies of the esophagus, further increasing diseases burden in EoE patients. Taking all of this factors into consideration, the main objective of this narrative review was to address challenges that pediatric patients with EoE on dietary treatment face with reference to current research and daily practice.  \nKeywords: eosinophilic esophagitis; dietary therapy; challenges; elimination diet  \n1. Introduction  \nEosinophilic esophagitis (EoE) is a chronic, allergic, immune-mediated inflammation of the esophagus caused by food antigens. The prevalence in the pediatric population is approximately 34 to 57 cases per 100,000 children, with a male to female ration 3:1 . This number may be underestimated due to diagnostic challenges and variety of clinical presentations in different age groups [1–3] . The symptoms of eosinophilic esophagitis (EoE) are highly varied and nonspecific, especially in the pediatric population. The diagnosis of EoE is a clinicopathologic one and requires the exclusion of other causes of eosinophilic inflammation of the esophagus [4,5] .  \nUpper gastrointestinal endoscopy (EGD) with biopsies remains the gold standard for both the diagnosis and monitoring of EoE. It allows for the assessment of characteristic  \nfeatures resulting from chronic inflammation and tissue remodeling. An efficient diagnostic process is clinically important because prolonged duration of undiagnosed EoE increases the risk of progression to a fibro-stenotic form of the disease and the development of permanent complications [6] .  \nUp to one-third of children with EoE may have a macroscopically normal-appearing esophag","cbCaikhRiMgTFP3d","https://ap.wps.com/l/cbCaikhRiMgTFP3d","pdf",243061,12,"English","# 1. Introduction\n## EoE definition, prevalence, and diagnostic principles\n## Endoscopy and biopsy sampling strategy\n## Histologic criteria and standardization\n## Treatment options and rationale for dietary therapy","[{\"question\":\"What is the recommended diagnostic basis for pediatric EoE?\",\"answer\":\"Diagnosis requires clinicopathologic assessment and exclusion of other causes of esophageal eosinophilic inflammation. It relies on histopathology from gastroscopy biopsies with a peak eosinophil count of at least 15 eosinophils per high-power field.\"},{\"question\":\"Why can EGD appearance be insufficient for confirming EoE?\",\"answer\":\"Up to one-third of children may have a macroscopically normal-appearing esophagus. Even when inflammatory features exist, they can be subtle, so endoscopic appearance alone cannot confirm or exclude the diagnosis.\"},{\"question\":\"What challenges are associated with dietary therapy in children with EoE?\",\"answer\":\"Elimination diets can target triggering factors and have limited systemic side effects when supervised, but the number of eliminated allergens may compromise quality of life. Additional challenges include nutritional risks, feeding disorders, financial burden, social life impairment, and increased disease burden from repeated endoscopic examinations for therapy effectiveness assessment.\"}]","Challenges in Dietary Therapy in Pediatric Eosinophilic Esophagitis (EoE) - A Narrative Review | PDF",1790772780]