Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a long-term (chronic) disease that affects your esophagus (the tube that carries food from your mouth to your stomach). It happens when eosinophils (a type of white blood cell) build up in your esophagus, causing inflammation. EoE involves your immune system. It’s often linked to food or environmental allergies. The condition affects both children and adults.

Eosinophilic esophagitis (pronounced “ee-oh-sin-uh-FILL-ik” “uh-saa-uh-JAI-tuhs”) can make it hard or painful to swallow. Many people feel like food or pills get stuck in their throat or chest. Sometimes, symptoms are more subtle — you may need to chew food very carefully, avoid pills or always drink water with meals.

If your child has EoE, you may notice that they’re not eating as much, or they gag or throw up meals. Or you may notice they’re not gaining weight as expected. Over time, ongoing swelling can damage your or your child’s esophagus.

EoE is a lifelong condition. But treatment can help manage symptoms and prevent problems. Treatment focuses on reducing inflammation. This may be through making dietary changes or taking medications. Sometimes, it involves a procedure that stretches the area. Many people need long-term treatment and regular follow-up care.

EoE symptoms

Eosinophilic esophagitis symptoms vary by age.

Adults may have:

• Trouble swallowing
• Food or pills getting stuck in your throat or chest
• Heartburn
• Chest pain
• Food or liquid coming back up

You may find yourself eating very slowly, chewing your food more than usual or feeling like you need to drink a lot of liquid to get food down.

Babies and children may have:

• Feeding trouble
• Vomiting
• Poor weight gain or growth problems
• Belly pain
• Refusing certain foods or textures
• Trouble moving from liquids to solid foods
• Heartburn
• Trouble swallowing
• Food getting stuck (in older children and teens)

Eosinophilic esophagitis causes

Experts don’t know the exact cause of EoE. They believe it happens when your immune system reacts to specific triggers. These triggers can include certain foods or allergens in the environment. This reaction causes eosinophils to collect in your esophagus and create inflammation.

Foods that commonly trigger EoE may include:

• Dairy
• Wheat
• Eggs
• Soy
• Nuts and peanuts
• Seafood and shellfish

People with EoE often have other allergic conditions. These include asthma, seasonal allergies, eczema and food allergies. That’s why you may have a nagging cough with EoE.

A small number of people doing oral immunotherapy (OIT) for food allergies develop EoE. It’s unclear whether you would have developed EoE regardless of doing OIT.

Risk factors

You may be more likely to develop EoE disease if you:

• Are male
• Have asthma, eczema or seasonal allergies
• Have food allergies
• Have a biological family history of EoE
• Have a close relative with trouble swallowing
• Are a child or young adult
• Have an autoimmune disease, like celiac disease, Crohn’s or colitis

Complications of this condition

Without treatment, EoE can lead to long-term swelling and scarring in your esophagus. Problems can include:

• Ongoing swallowing problems
• Feeding and growth problems
• Narrowing of your esophagus 
• Reduced quality of life

Some of these, like food getting stuck, can require emergency medical treatment. If food is stuck for too long, it can cause damage to your esophagus lining. If you’re having trouble swallowing your saliva, there’s a risk of liquid or food getting in your airway (aspiration).

How doctors diagnose this condition

A healthcare provider will ask about your symptoms, eating habits, allergy history and family history. They may suspect EoE if you have long-term swallowing problems or issues with food getting stuck. (Or if your child has trouble feeding.) Your provider may refer you to a specialist, like a gastroenterologist or an allergist.

To make an EoE diagnosis, your provider may do an upper endoscopy with biopsies. During this test, your provider uses a thin tube with a camera to look at your esophagus. They’ll take small tissue samples. They’ll likely take several biopsies from different parts of your esophagus. EoE can affect areas unevenly.

During an endoscopy, your provider may see:

• Rings in your esophagus
• Narrowed areas
• Swelling
• Small white spots
• Long grooves or furrows

A lab will examine the tissue samples under a microscope. Your provider will usually diagnose EoE when there are at least 15 eosinophils in a high-power field. They also need to rule out other causes.

Some children may also have a barium swallow test to check for narrowing.

Eosinophilic esophagitis treatment

EoE treatment goals include reducing swelling, improving symptoms, and preventing scarring and narrowing.

Treatment options may include:

• Proton pump inhibitors: These can reduce acid and protect your esophageal barrier.
• Swallowed topical steroids: Steroids, like budesonide or fluticasone, can reduce swelling.
• Dietary changes: Your provider may discuss a specific type of elimination diet to help you find and remove food allergens. Allergy testing doesn’t identify food triggers.
• Dupilumab: An injection of this biologic is also an option. You self-inject it once a week at home.
• Esophageal dilation: This is a procedure that gently stretches narrowed areas of your esophagus.

You’ll need long-term treatment because symptoms and inflammation will return if you stop. But you can often make changes based on your preference or if the initial treatment isn’t working.

Recovery time

Recovery depends on your symptoms and treatment type. Some people start feeling better within days or weeks after starting medication. Others may need several months to find the right treatment plan. You’ll need regular follow-up visits and repeat endoscopies to check healing and look for complications.

When should I see my healthcare provider?

Talk to your provider if you or your child has:

• Trouble swallowing
• Frequent vomiting
• Food getting stuck
• Feeding problems
• Poor growth or weight gain
• Heartburn
• Chest pain

Seek emergency care if food becomes completely stuck and you can’t swallow saliva or liquids.

What can I expect if I have EoE disease?

EoE is a lifelong, chronic condition. Without treatment, the swelling may continue. It can cause scarring or narrowing in your esophagus over time.

Most people can manage EoE successfully with medication, changes to what they eat or both.

EoE doesn’t shorten life expectancy. But regular care is important to help prevent problems and protect your ability to swallow comfortably.

What’s the difference between eosinophilic esophagitis and eosinophilic gastritis?

Both conditions are types of eosinophilic gastrointestinal disease (EGID). All EGIDs involve high numbers of eosinophils in different parts of your digestive system. Eosinophilic gastritis affects your belly, while eosinophilic esophagitis affects your esophagus. Other types are:

• Eosinophilic colitis (EC) involves your large intestine (colon).
• Eosinophilic duodenitis affects the first part of your small intestine.
• Eosinophilic enteritis (EoN) affects your small bowel.
• Eosinophilic gastritis affects your stomach.
• Eosinophilic gastroenteritis (EGE) primarily affects your stomach and intestines.