A Canadian multicenter pediatric eosinophilic esophagitis cohort: Evidence for a nondilation approach to esophageal narrowing.

Objectives: Improving characterization of the narrowing phenotype in pediatric eosinophilic esophagitis (EoE). Methods: New pediatric EoE diagnoses from 2015 to 2018 were retrospectively identified in Vancouver (BC), Northern Alberta (AB), Hamilton (ON), and Nova Scotia (NS). Incidence rates were calculated using 2016 Federal census data. Clinical, endoscopic, and histologic data were gathered from diagnosis until the end of the follow-up period (fall 2019). Results: The incidence of EoE in patients less than 15 years old was 5.4 per 100,000 person-years. Of the 332 new diagnoses, 40 (12.0%) had endoscopically identified esophageal narrowing at diagnosis or during the follow-up period, with a subset of 11 (27.5% of narrowed cohort) patients undergoing mechanical esophageal dilation. The median age at diagnosis and median duration of symptoms were higher in the cohort with narrowing than those without. Patient-reported food bolus impaction and dysphagia were associated with esophageal narrowing. Trachealization was the endoscopic finding most commonly associated with esophageal narrowing. Of the 65 esophagogastroduodenoscopies performed in the follow-up of a known esophageal narrowing, 4 of the 31 (13%) had resolution of this finding post mechanical dilation, and 19 of the 39 (49%) had resolution of the narrowing after initiation of new medical or dietary treatments (without dilation). Conclusions: EoE is common in Canadian children, with esophageal narrowing being present within a few years of diagnosis in 12% of cases. Interestingly, a large portion of narrowing resolved