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Background: Diagnosis alid management of eositiophilic esopliagitis (EoE) occur via esoplingogastroditodenoscopy with tissue biopsy. Objective: We sought to determine if salivary 11!ic-oribonucleic acid (miRNA) levels could differentiate children with EoE, serving as a noninvasive biomarker. Methods: Saliua was collected from children lindergoing esophagogastroduodetioscopy (N = 291). miRNA analysis was conducted on 150 samples: EoE (n = 50), no pathologic alteration (11 = 100). RNA zons quantified with high throtigliput sequencing and aligned to build hg38 of the litiman genome ilsing sequencing mid alignment software, Quantile norinalized levels of roblistly expressed miRNAs (rail) coullts > 10 in 10% of samples) were compared across EoE m:id non-EoE grolips with WilcOX011 rank sum testing. miRNA biomarker candidates were selected based on variable importance projection (VIP) scoring with partial least squared discriminant allalysis (VIP > 1.5). Ability of these miRNAs to differentiate EoE status ions assessed via logistic regression. Putative biologic targets for the miRNA candidates were deterinined in miRNA patlizpay analysis software. Results: Of the 56 saliuary miRNAs reliably detected, miR-205-5p displayed tlie largest difference between EoE mid non-EoE groups (V = 1623, adjusted p = 0.029). Six iitiRNAs (miR-26b-5p, miR-27b-3p, Let-7i-5p, iliR-142-5p. 11!iR-30a-5p, miR-205-5p) displayed elevated VIP scores (>1.5) aild were able to differentiate EoE santples on logistic regression analysis tuith 70% sensitivity alid 68% specificity. These six mil*As demonstrated significant emicliment for gene targets involved in valine, leucine, and isoleucine biosyntliesis (p= 0.0012), 2-oxycarboxylic acid nletabolism (p = 0.043), and steroid hormone biosynthesis (p = 0.048). Conclusions: Salivary miRNAs represent a noninuasive, biologically relevant measure that may aid disease nionitoring of EoE. [ABSTRACT FROM AUTHOR]