Barriers to treatment adherence in pediatric eosinophilic esophagitis.

Objectives: Treatment adherence in pediatric patients with eosinophilic esophagitis (EoE) is suboptimal. This study aimed to identify barriers to adherence, comparing experiences between patients on elimination diets and those prescribed medication. Methods: This observational study utilized a questionnaire incorporating elements from a previously validated medication adherence tool, in addition to studies assessing dietary and medication adherence in pediatric gastrointestinal disorders. Results: A total of 125 patients were enrolled. Among them, 94 patients were prescribed medication, and 58 patients were prescribed dietary elimination, with 27 subjects receiving both medication and dietary elimination. High rates of nonadherence were observed in both groups. In the pharmacological group, the most common barrier was forgetting to take medication, particularly among those prescribed swallowed topical corticosteroids. In the dietary therapy group, limited food options and challenges when away from home were key barriers. Furthermore, older children, those unsupervised by parents, and those living in single or separate households exhibited lower adherence to dietary therapy. Conclusion: Shared decision-making between healthcare providers, patients, and their families is critical for optimizing treatment adherence in pediatric EoE. Our findings offer new insights into the barriers to dietary and pharmacologic treatment in pediatric EoE, and understanding and addressing these barriers may enhance long-term treatment adherence and improve quality of life for this population.