Objective: To analyze the details of our clinical series of 15 children with eosinophilic esophagitis (EE), focusing the attention on the main clinical manifestations. and endoscopic features in order to better understand the diversity of the disease, thereby improving clinical diagnosis and treatment. Patients and methods: In the last 5 years, EE was diagnosed in 15 patients (11 males, age range 2-18 years, mean age 10.5 years). All patients underwent to an upper endoscopy with multiple biopsy specimens of the esophagus under conscious sedation. EE was defined as greater than 20 eosinophils per high power field after conventional anti-reflux treatment. All patients were tested for food allergies. Results: All studied patients were referred to our Unit after failure of antireflux therapy. The presenting symptoms were dysphagia (63%), vomiting (36%), food bolus impaction (20%), epigastric pain (18%) and chronic anemia (9%). Dysphagia and vomiting were the most common symptom, especially in the younger children, while food bolus impaction for esophageal stenosis occurred in 3 older patients. Endoscopic findings were always aspecific: normal esophagus in 6 cases (40%), low grade hyperemia in 5 (33%); high grade hyperemia in 1 (7%) and esofageal stricture in 3 (20%). The majority of allergic tests resulted negative. All patients were successively treated with swallowed corticosteroids. After 3-4 months, the corticosteroid was substituted by leukotriene receptor antagonists. Corticosteroid therapy was effective in all cases, with a rapid regression of symptoms in all children. However, after the suspension of medications, all children presented a recurrence of the disease, therefore were treated by montelukast as maintenance treatment. A mean follow-up of 2 years was based on periodical clinical evaluations and by repeated endoscopies and biopsies. Conclusions: EE is an emerging clinical entity, probably still underestimated, characterized by age-related symptoms. It has to be always ruled out in case of important clinical manifestations in the absence of a clear GERD condition, in order to avoid major esophageal complications. Montelukast offer benefit as maintenance treatment.