Digestive Health

What Is Eosinophilic Esophagitis (EoE)? Symptoms, Causes, Diagnosis, and Treatment

Julie Lynn Marks
By Medically Reviewed by 
Reviewed:
Medically Reviewed
eosinophilic esophagitis illustration

Eosinophil cells aren’t supposed to be in the esophagus. The presence of wayward cells suggests EoE, an immune system disease that causes difficulty swallowing.

 

Laurie O'Keefe
Eosinophilic esophagitis (EoE) is a chronic immune system disease of the esophagus — the “food tube” that connects your mouth to your stomach, according to Mayo Clinic.

With EoE, certain white blood cells associated with allergic reactions, called eosinophils, accumulate in the lining of the esophagus, notes MedlinePlus.

In a normal esophagus, no eosinophils are present, according to the American Academy of Allergy, Asthma & Immunology.

Signs and Symptoms of Eosinophilic Esophagitis (EoE)

The buildup of eosinophils causes damage and inflammation that can bring on a wide range of issues. Symptoms of EoE vary from person to person and may depend on your age, notes the American Partnership for Eosinophilic Disorders.

Per the American Academy of Family Physicians, symptoms in adults may include:

  • Difficulty swallowing (dysphagia)
  • Food impaction (food gets stuck in the esophagus)
  • Throat pain
  • Reflux symptoms, such as burping, bad taste in the mouth, regurgitation, or burning, that don’t improve with medicines

Older children may experience:

  • Abdominal pain
  • Vomiting
  • Trouble swallowing
  • Food impaction
  • Poor appetite
  • Reflux that doesn’t improve with medicines
Some possible symptoms in babies and toddlers include:

  • Poor appetite or growth
  • Feeding problems
  • Vomiting
  • Reflux that doesn’t improve with medicines
Food getting stuck in your esophagus can be an emergency situation that requires prompt medical attention.

Some people with EoE experience periods of time where symptoms become suddenly worse. These flare-ups may be seasonal, often occurring in the spring, summer, or fall when pollen counts are higher and people are more likely to be outdoors.


    Causes and Risk Factors of Eosinophilic Esophagitis (EoE)

    The exact cause of EoE isn’t known, but experts believe the condition is usually triggered by the body’s immune response to certain foods or substances in the environment, like dust mites, pollen, dander, or mold.

    Many people with EoE report having food allergies. About half also suffer from seasonal allergies or asthma.

    But people with neither food allergies nor asthma can have EoE.
    Researchers believe that both environmental and genetic factors play a role in EoE.

    Two genes that are known to contribute to EoE are CAPN14 and TSLP, according to the National Organization for Rare Disorders.

    Anyone can develop EoE, but you may be more at risk if you:


    • Have family members with the condition
    • Are male
    • Have other allergic diseases, such as eczema, hay fever, asthma, or food allergies
    • Are exposed to seasonal allergens

    How Is Eosinophilic Esophagitis (EoE) Diagnosed?

    Diagnosing EoE can be tricky because symptoms often mimic those of other conditions, such as gastroesophageal reflux disease (GERD).

    Many people with EoE also experience a delayed diagnosis because of a lack of awareness about the condition. EoE is considered a relatively new disease that’s only been identified since the early 1990s.

    A correct diagnosis of EoE should be confirmed by an allergist or gastroenterologist.

    To make an accurate diagnosis, your doctor may perform the following:

    • Physical exam During this process, your provider might ask you about your symptoms and family history.
    • Endoscopy A long, flexible tube with a light and camera on the end is placed down your esophagus. Your doctor will look for signs of EoE, which may include narrowing, inflammation, white spots, or rings.
    • Biopsy While performing an endoscopy, your doctor takes small tissue samples from your esophagus. The samples are examined for eosinophils. A biopsy is the only way to confirm a diagnosis of EoE.
    • Other tests Sometimes blood tests, food allergy testing, or other exams may be given.
    With EoE, it’s often difficult to identify which foods may be causing problems because the reactions are delayed and can develop over days.

    Doctors may suggest an elimination diet to learn more about your diagnosis and how to treat your condition. With this diet, you stop eating or drinking certain foods for several weeks and add them back one at a time to try and pinpoint which foods trigger a reaction, according to the American College of Gastroenterology.

    Your doctor might perform a follow-up endoscopy as the foods are added back to your diet to help determine which are causing your EoE symptoms.

    Learn More About Diagnosing Eosinophilic Esophagitis (EoE): Tests, Early Diagnosis, and Your Doctors 

    Prognosis of Eosinophilic Esophagitis (EoE)

    Researchers are still learning about the prognosis and long-term effects of EoE.

    Studies have shown some patients may experience flare-ups followed by periods of remission (where signs and symptoms of the disease go away). There have also been reports of spontaneous remission in people with the disease, but the risk of a relapse isn’t known, according to an article published in September 2018 in Allergy, Asthma, & Clinical Immunology.

    EoE doesn’t appear to affect life expectancy. Additionally, current research suggests that the disease does not increase your risk of developing esophageal cancer.

    While the outlook varies among individuals with EoE, with proper treatment and lifestyle changes, you can effectively manage your disease and maintain a good quality of life.

    Duration of Eosinophilic Esophagitis (EoE)

    EoE is considered a chronic condition that you will have to deal with for your entire life. Most people with EoE will need to stay on some type of treatment or diet to control their symptoms.

    While EoE isn’t considered a life-threatening condition, it’s important to seek treatment. Unmanaged EoE can cause long-term damage to your esophagus.

    Treatment and Medication Options for Eosinophilic Esophagitis

    Therapy often starts with some medications approved for other conditions that may help symptoms of EoE. These include:

    • Proton pump inhibitors (PPIs) These drugs lessen acid production in the stomach and may reduce inflammation in the esophagus. But not all patients with EoE respond to PPIs.

    • Topical steroids They can help control inflammation in the esophagus. You swallow the liquid steroid. The type of steroids doctors typically prescribe for EoE isn’t absorbed in the bloodstream, so you probably won’t experience side effects normally associated with steroids.

    In May 2022, the U.S. Food and Drug Administration (FDA) approved dupilumab (Dupixent) as the first drug to specifically treat EoE in adults and children over 12. The drug, which is already approved to treat atopic dermatitis (eczema), eosinophilic or oral steroid dependent asthma, and inadequately controlled chronic rhinosinusitis with nasal polyps, is the only treatment yet to be approved for EoE.

    Dupixent is a monoclonal antibody, injected weekly, that works to inhibit inflammation.

    Your doctor might also recommend esophageal dilation if you have a narrowed esophagus. This procedure is done to stretch esophageal strictures and make it easier to swallow.

    Dietary Therapies and Food Strategies

    Dietary therapies play a significant role in helping many people with EoE control their symptoms. Typically, these strategies involve removing certain food triggers. Common foods to avoid include:

    • Milk
    • Wheat
    • Eggs
    • Soy
    • Peanuts and tree nuts
    • Fish and shellfish
    The two main types of dietary plans for people with EoE are:

    • Elimination diet For this plan, you eliminate certain foods or beverages for several weeks and add them one at a time to see which may be problematic. You might have an allergy test first to determine which foods to avoid.
    • Elemental diet With this approach, you stop eating and drinking all proteins and consume an amino acid formula instead. If your symptoms go away, you might be able to add foods back one at a time to see if you can tolerate them. If you have difficulty drinking the formula or you’re not getting adequate nutrition, your doctor may place you on a feeding tube. Because this is such a difficult diet to follow, it’s rarely done.
    It’s important to know that it might take time, sometimes weeks, after eliminating a certain food to know whether the strategy worked, notes Johns Hopkins Medicine.

    You may want to generally avoid any foods, drinks, or substances that trigger or worsen your heartburn, such as:

    • Tomato sauce
    • Alcohol
    • Fried or fatty foods
    • Chocolate
    • Garlic
    • Onion
    • Mint
    • Caffeine

    RELATED: 12 Gluten-Free Desserts as Delicious as They Are Easy to Make

    RELATED: What to Eat and Avoid on a Plant-Based Diet, and a 14-Day Sample Menu

    Alternative and Complementary Therapies

    Coping with a chronic disease like EoE can cause you to feel stressed or anxious, noted research published in 2019 in the Journal of Asthma and Allergy.

    Symptoms may crop up unexpectedly in social situations or at inopportune times, which could lead to embarrassment.

    Adopting a healthy lifestyle and keeping stress levels at bay may help you manage your symptoms and feel better overall.

    As the Cleveland Clinic notes, some ways to control stress include:

    Research also suggests maintaining a healthy weight may help improve symptoms of heartburn. Extra pounds put pressure on your abdomen, which can cause acid to back up into your esophagus. Daily exercise paired with a healthy diet can help you keep your weight under control.

    Prevention of Eosinophilic Esophagitis (EoE)

    There’s no way to prevent EoE from developing, but there are effective strategies to manage your symptoms.

    Be sure to follow the dietary plan you and your doctor select. Deviating from the diet, even a little, can lead to inflammation of the esophagus. What’s more, it may take days or weeks for a food-related reaction to occur.

    If your EoE is related to environmental allergies, try to avoid the triggers as much as possible.

    Complications of Eosinophilic Esophagitis

    In some cases, EoE can lead to complications, such as:

    • Damage to the esophagus Inflammation of the esophagus makes tearing or perforation more likely. This damage can occur when you get food stuck in your esophagus or as the result of an endoscopy.
    • Narrowing or scarring of the esophagus When your esophagus narrows, it makes swallowing more difficult and puts you at risk of food impaction.

      Your doctor can stretch the narrowing with a procedure called dilation (mentioned above in the section on treatments), which can be done during an upper endoscopy.

    Research and Statistics: How Many People Have Eosinophilic Esophagitis?

    EoE affects about 1 in 2,000 people in the United States.

    The number of individuals diagnosed with EoE has been increasing in recent years. Researchers believe this surge is partly due to more awareness of the disease.

    In a study published in June 2021 in the Annals of Gastroenterology, researchers examined the costs associated with treating EoE patients.

    Their analysis showed that hospitalization rates for EoE-related admissions in the United States increased by about 70 percent from 2010 to 2016. They also reported that these hospitalizations accounted for more than $24 million a year in costs.
    Experts aren’t exactly sure about the other factors that might contribute to a rising number of EoE cases, but according to Harvard Health Publishing, some possible theories include:

    • Fewer childhood infections might lead to more allergic diseases.
    • The typical Western diet could alter the population’s microbiome.
    • Environmental factors, such as chemical additives, genetic crop modifications, pollutants, or food processing may be contributors.
    • Fewer Helicobacter pylori (H. pylori) infections (a common cause of peptic ulcers) may mean less protection against some allergic diseases.
    • More cases of GERD could correlate with more instances of EoE. The idea is acid reflux might break the barrier of the esophagus and allow food allergens to stimulate the immune system.
    • Increased use of acid-suppressing drugs, especially early in life, might change the microbes in the esophagus or raise a person’s risk of developing a food allergy.
    People of all ages and ethnic backgrounds can develop EoE. The disease affects more men than women and is more likely to develop in someone with allergies or asthma.

    EoE is most common among men in their twenties and thirties.

    Studies have reported cases of EoE in various countries an all continents, with the exception of Africa.

    Related Conditions and Causes of Eosinophilic Esophagitis

    Certain disorders may look like EoE or occur along with it.

    Some conditions closely related to EoE include:

    Resources

    If you or your child has EoE, you’re not alone. Many resources provide support and helpful information.

    Favorite Orgs for Essential EoE Info

    American Partnership for Eosinophilic Disorders (APFED)

    APFED is a nonprofit that was started in 2001 by a group of mothers whose children had EoE. This organization is dedicated to improving the lives of patients and families living with EoE. They provide an array of education, awareness, advocacy, and support opportunities.

    Campaign Urging Research for Eosinophilic Disease (CURED)

    CURED is committed to raising funds and increasing awareness for EoE and other eosinophilic gastrointestinal diseases. To date, the organization has donated more than $5.5 million to research.

    EOS Network

    The EOS Network’s mission is to ensure that every person with an eosinophilic gastrointestinal disease receives a prompt, accurate diagnosis; the right treatment for them; and support to live with their condition. We especially love their recipes and cooking tips section for ideas on how to keep mealtimes interesting, even if you’re cutting out certain foods.

    Favorite Professional Organizations for EoE

    American Academy of Allergy, Asthma, and Immunology (AAAAI)

    The AAAAI is a professional membership organization that includes more than 7,000 allergists and immunologists. On their site, you can take a quiz to see how much you know about EoE. We also like their Find an Allergist page, which helps you locate a qualified allergist or immunologist in your area.

    American College of Allergy, Asthma, and Immunology

    This professional organization promotes excellence in patient care. They provide credible information about EoE. We like their Ask the Allergist section, which gives answers to common questions asked by the public.

    American College of Gastroenterology (ACG)

    The ACG is comprised of a group of professionals that promote prevention, diagnosis, and treatment of digestive disorders. Their site provides in-depth information about various digestive health topics, including EoE.

    International Eosinophil Society (IES)

    The IES is a group of scientists and clinicians who have an interest in eosinophil diseases. The organization was established to bring together scientists from around the world who are involved in eosinophil biology and eosinophil disorders research.

    Favorite Online Support Networks

    EOS Connections

    APFED’s online support community, EOS Connections, provides a platform for patients, caregivers, and family members to connect with others and share information. Additionally, you can find a list of local eosinophilic support groups on APFED’s page.

    Favorite Resource for Diet Advice

    University of Wisconsin (UW): Elimination Diet Patient Handout

    This handout, created by UW Integrative Health, provides a wealth of information about the elimination diet. We like the printable food diary chart for logging food and beverage consumption.

    Food Allergy Research and Education (FARE)

    FARE works to improve quality of life for people with food allergies. Their site offers educational tools and research, including information about the elimination diet and U.S. laws and regulations regarding food allergies.

    Favorite Blog for EoE

    The EoE Guru

    This blog, written by a patient who has lived with EoE for 35 years, provides both personal accounts and educational information.

    Favorite Patient-Centered Medical Conference

    APFED’s EOS Connection

    APFED’s EOS Connection Patient Education Conference is an annual event where attendees can network with patients, families, and other community members, and learn about new resources and research.

    Editorial Sources and Fact-Checking

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