Eosinophilic Esophagitis: real-life outcomes over 10 years in a Canadian pediatric centre.

Objective: Despite Eosinophilic Esophagitis (EoE) being a chronic condition, many studies focus on the short-term. This study characterizes patients, treatment effectiveness and outcomes in a pre-biologic era. Methods: This cohort study (2012-2022) at British Columbia (BC) Children's Hospital in Vancouver, Canada analyzed data from the EoE Registry which was hosted on Research Electronic Data Capture (REDCap) for participating patients <18 years with biopsy-proven diagnosis (≥15 eosinophils/hpf) including demographics, symptoms, allergic history, medications, endoscopy and histology. Results: 247 patients (71.2% White, 16.7% South Asian, 78.1% male, median age 9 years) were followed over a median 3-year follow up. 85.2% had at least one atopic condition and 17.4% reported Cow's Milk Protein Allergy in infancy. 19.0% lacked follow up endoscopy and in clinic follow-up, 18.2% were on no therapy. At last endoscopy of those on treatment (n = 200), 39.0% used swallowed topical corticosteroids (50.0% remission), 23.0% proton pump inhibitors (29.0% remission), and 39.0% elimination diets (34.0% remission). Over half on medications had imperfect adherence. Overall, 39.0% achieved remission (<15 eosinophils/hpf), (mean peak eosinophils decreased from 55 to 27/hpf, strictures from 7.5% to 2.7%). Conclusions: This Canadian study reveals remission rates lower than short term studies, but a reduction in strictures in follow-up. Real-life challenges, such as not returning for follow up endoscopy (∼20%), despite no direct care costs, challenges with adherence with ∼20% not taking any therapy and over half not taking medications as prescribed contribute towards remission rates below 50% regardless of treatment. Better patient engagement, addressing barriers to treatment and follow up and exploring novel therapies are needed.