Pediatric Asthma Screening Identifies High Prevalence of Eosinophilic Esophagitis
Key Clinical Summary
- Systematic eosinophilic esophagitis (EoE) screening in a tertiary pediatric asthma/allergy clinic identified a projected EoE prevalence of 8.0%, increasing to 13.9% after accounting for nonparticipants and patients lost to follow-up.
- Among 189 children with asthma, 80.4% screened positive for concerning symptoms, and 8 of 24 patients (33%) who underwent endoscopy were diagnosed with EoE.
- The findings suggest that routine symptom-based screening in high-risk pediatric asthma populations may facilitate earlier EoE diagnosis, potentially reducing fibrostenotic complications and diagnostic disparities.
Children receiving specialty care for asthma may have a substantially higher prevalence of eosinophilic esophagitis (EoE) than previously recognized, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice. Investigators found that implementing a simple, noninvasive screening strategy in a tertiary pediatric asthma and allergy clinic increased EoE detection and identified a notable burden of previously unrecognized disease.
Researchers sought to estimate the prevalence of EoE among pediatric asthma patients using a modified Pediatric Eosinophilic Esophagitis Symptom Severity (PEESS v2.0) questionnaire. The screening tool was administered to children aged 7–17 years with asthma and to parents of children aged 3–6 years attending a tertiary asthma and allergy clinic. Patients with symptoms considered concerning for EoE by the treating allergist were referred for gastroenterology evaluation, with endoscopy performed when clinically indicated.
The study enrolled 189 participants, of whom 152 (80.4%) screened positive for symptoms suggestive of EoE. Among those screening positive, 72 patients (47.4%) were referred to gastroenterology, and 44 (61.1%) completed the referral. Twenty-four patients ultimately underwent upper endoscopy, and 8 (33%) received a diagnosis of EoE.
Based on these findings, investigators estimated an overall EoE prevalence of 8.0% (95% CI, 5.1%–11.7%) among pediatric asthma patients in the clinic. When adjusting for nonparticipants and patients who did not complete follow-up, the projected prevalence increased to 13.9% (95% CI, 10.1%–18.4%).
Among individual screening symptoms, vomiting was the only symptom significantly associated with an EoE diagnosis (P = .001). Investigators also reported that demographic characteristics of patients diagnosed with EoE closely reflected the overall study population, with 75% identifying as non-White.
Clinical Implications
EoE is a chronic, progressive inflammatory disease that frequently coexists with other atopic conditions, including asthma. Because diagnosis is often delayed, patients may develop fibrostenotic complications, including esophageal strictures, as well as impaired growth. The study suggests that targeted symptom screening within pediatric asthma clinics may help identify patients requiring further gastroenterology evaluation before irreversible complications develop.
The findings also highlight the potential value of integrating allergy and gastroenterology care for children with asthma who report upper gastrointestinal symptoms. Investigators noted that systematic screening increased recognition of previously undiagnosed disease and may help reduce racial disparities in diagnosis, given that the demographic profile of diagnosed patients reflected the clinic population. Additional research is needed to optimize screening instruments and determine whether similar approaches should be adopted across broader atopic populations.
Expert Commentary
The investigators concluded that "screening in a pediatric asthma clinic identified a previously unrecognized high prevalence of EoE." They further noted that this strategy "may facilitate earlier diagnosis, prevent fibrostenotic complications, and reduce racial disparities," while emphasizing that additional studies are needed to refine screening tools and evaluate applicability across atopic populations.
This study demonstrates that systematic symptom screening in a tertiary pediatric asthma clinic identified a higher-than-expected prevalence of eosinophilic esophagitis. The findings support further evaluation of targeted screening strategies to promote earlier diagnosis and improve care for children at increased risk of EoE.
Reference:
Becker RE, Chugh A, Lee R, et al. Screening for eosinophilic esophagitis in the pediatric asthma clinic leads to increased diagnosis and identifies a high prevalence of disease. J Allergy Clin Immunol Pract.Articles in press June 23, 2026. https://www.jaci-inpractice.org/article/S2213-2198(26)00512-X/abstract
