Background: Eosinophilic esophagitis (EoE) is a chronic immune mediated esophageal disease, typically manifests with nonspecific gastrointestinal symptoms in pediatric patients.

Aim: our study aimed to comprehensively analyze the clinical features, diagnostic findings, and treatment responses among pediatric EoE patients at Sulaymaniyah Pediatric Teaching Hospital, Kurdistan, Iraq.

Patients and Methods: This retrospective cross-sectional study conducted from May 2020 to February 2025. Medical records were reviewed for 30 patients aged 2–18 years who had been diagnosed with EoE by upper gastrointestinal endoscopy and histopathological confirmation. Data on demographics, clinical presentation, endoscopic and histopathological findings, laboratory results, and treatment outcomes were collected.

Results: Thirty children (mean age 6.41 ± 2.94 years; 60% male) were included. Dysphagia 19 (63.3%), food impaction 7 (23.3%), and vomiting 4 (13.3%) were the most common symptoms. Atopy was present in 70% of cases. Abnormal endoscopic findings were observed in 22 (73.3%), with furrowing 25 (83.3%) and ring formation 19 (63.3%) being most frequent. All patients had histopathological confirmation of EoE; 27 (90%) had multi segmental involvement. Elevated serum IgE and eosinophil counts were found in 9 (30%). Only 10 patients (33.3%) underwent follow-up for treatment response; 8 (80%) showed clinical and histological remission after 12 weeks of local corticosteroids, PPIs, and dietary elimination.

Conclusions: EoE in this pediatric cohort presented predominantly with dysphagia and atopic history. Multi segmental esophageal involvement and characteristic endoscopic features were common. Combined pharmacological and dietary therapy was effective in most treated cases. Improved awareness and follow-up are needed for optimal management.