Clinical and Growth Characteristics of Children With Eosinophilic Esophagitis With and Without an Atopic Background

Abstract Purpose To determine whether atopic background is associated with differences in clinical phenotype, growth, disease severity, treatment, and remission outcomes in children with eosinophilic esophagitis (EoE). Methods We conducted a retrospective cohort study of children (< 18 years) diagnosed with EoE at a tertiary pediatric gastroenterology center between 2010 and 2025. Atopy was defined as physician-diagnosed asthma, allergic rhinitis, atopic dermatitis, or IgE-mediated food allergy. Patients were stratified by atopic status and systematically compared. Results The cohort included 139 children (79.9% male; median age 9.9 years), of whom 73 (52.5%) had atopy. Parental atopy was more common among atopic patients (17.8% vs. 6.1%, P = 0.04). At diagnosis, atopic children had significantly lower weight and height percentiles (P = 0.02 for both). No significant differences were observed in perinatal characteristics, presenting symptoms, endoscopic or histologic findings, treatment approaches, or time to remission. Conclusion Atopic background does not define a distinct pediatric EoE phenotype but is associated with lower baseline growth parameters. Close growth monitoring and tailored nutritional support are warranted in atopic patients.