Eosinophilic Esophagitis (EoE): Signs & Treatments

Eosinophilic esophagitis (EoE) is a chronic (long-term) condition affecting the esophagus, the tube that carries food and liquids from the mouth to the stomach. EoE causes symptoms like difficulty swallowing, abdominal pain, vomiting, and poor appetite.

In the United States, EoE affects about 1 in 700 people. It’s most common in people with allergic conditions like asthma, eczema, or seasonal allergies.

While there is no cure, treatments like dietary changes, medications, and medical procedures can reduce inflammation and improve symptoms.

The main symptom of eosinophilic esophagitis is difficulty swallowing. Inflammation in the esophagus can damage tissue, making it hard for food to pass smoothly from the mouth to the stomach. Other EoE symptoms can vary by age. 

Symptoms in Infants and Young Children 

It’s common for infants and young children with EoE to have a hard time feeding (drinking milk or formula). While these children may be too young to verbally tell you they’re uncomfortable, you can look for signs of their discomfort. Common EoE symptoms in infants and toddlers include: 

• Poor appetite or refusal to eat 
• Coughing while feeding
• Vomiting
• Poor weight gain or growth
• Arched back while vomiting or spitting up (a sign of pain) 

Symptoms in Children

EoE symptoms may be mistaken for picky eating or unrelated digestive issues in children. EoE symptoms in children can include: 

• Difficulty swallowing 
• Food impaction (food getting stuck in the throat)
• Nausea and vomiting 
• Abdominal pain
• Poor growth or weight loss 
• Refusal to eat or poor appetite
• Fullness after eating small amounts of food 
• Regurgitation (food flowing back into the esophagus) 

Symptoms in Teens and Adults

In teens and adults, common EoE symptoms include: 

• Trouble swallowing, especially solid foods 
• Food getting stuck in the esophagus
• Upper abdominal or chest pain 
• Persistent heartburn or reflux-like symptoms (acid or food backing up into the mouth from the stomach and esophagus) 

Eosinophilic esophagitis occurs when eosinophils—a white blood cell that helps fight infections and plays a role in the body’s immune response to allergies—build up in the lining of the esophagus. The eosinophils release inflammatory substances that can damage the esophagus’s tissue, causing symptoms like difficulty swallowing. 

The exact cause of EoE is not fully understood, but a combination of genetic and environmental factors may play a role. Eosinophils often build up in the esophagus due to an overactive immune response to specific triggers, such as food or environmental allergens.

Foods commonly associated with triggering allergic and EoE symptoms include eggs, dairy, soy, gluten, tree nuts, and fish.

Environmental allergens, such as pollen, can also contribute to EoE. Many people with EoE and seasonal allergies have worse EoE symptoms during the spring and summer (allergy season) when grasses and trees are pollinating. 

Risk Factors

Certain factors can increase the likelihood of developing the condition, including: 

• Sex: Males are three times more likely to develop EoE than females. 
• Race: EoE can affect people of all races, but it is most common among white people. 
• Family history: People with a family history of EoE have a slightly higher risk of developing the condition. 
• Allergic conditions: People with asthma, eczema, food allergies, or hay fever (seasonal allergies) are at higher risk.

To diagnose eosinophilic esophagitis, a healthcare provider will likely review your personal and family medical history. They may also ask about your symptoms, perform a physical examination, and order diagnostic tests.

The following tests can help rule out other possible causes of symptoms and confirm an EoE diagnosis:

• Upper endoscopy: An endoscope (a long, narrow tube with a light and camera) is inserted into your mouth and throat. The tool can help your healthcare provider see the esophagus to check for signs of inflammation, such as redness and swelling, or other abnormalities common with EoE, such as scarring or narrowing of the esophagus.
• Biopsy: During upper endoscopy, your healthcare provider may take a biopsy (a small tissue sample) from the esophagus. The sample will be examined under a microscope to determine whether it contains eosinophils. Fifteen or more eosinophils in the tissue generally indicate EoE. 
• Blood tests: Your healthcare provider may take blood samples from a vein in your arm and send them to the lab for testing. They will measure for high eosinophil counts or inflammation markers. 
• Allergy testing: If your healthcare provider suspects allergies are causing EoE, they may order allergy testing, such as a skin prick test, to determine whether food or environmental allergies are triggering EoE symptoms. 

Treatment for eosinophilic esophagitis focuses on lowering inflammation to manage symptoms and prevent complications. While there is no cure, medications and lifestyle changes can help you get to remission—when inflammation is low or gone and symptoms are under control.

Treatment plans can vary from person to person, depending on the severity of inflammation and specific triggers. 

Dietary Management 

Dietary changes can help control inflammation and reduce symptoms when food allergies cause or contribute to EoE. There are three main diets healthcare providers often recommend for people with EoE: 

• Empiric elimination diet: This approach involves removing the most common food allergens from your diet, including dairy, wheat, soy, eggs, nuts, and seafood. After several weeks, your healthcare provider will recommend adding each food back into your diet one at a time. They will order periodic endoscopies to see which food is causing inflammation in your esophagus.
• Testing-directed elimination diet: This approach uses allergy testing, such as skin prick or blood tests, to identify potential food allergens to remove. While this method may lower the need for unnecessary dietary restrictions, it’s not always as effective as other elimination diets because allergy tests don’t always accurately identify all EoE triggers.
• Elemental formula diet: In severe cases, healthcare providers may recommend replacing all whole foods with an amino acid-based, allergen-free formula. Healthcare providers often recommend this diet for infants and young children with poor growth or people with severe inflammation of their esophagus. 

Medications

Prescription medications can help control inflammation, reduce EoE symptoms, and promote healing. Common medications for treating EoE include: 

• Steroids: Swallowing liquid steroids or using an inhaler to breathe in and swallow steroids can help reduce inflammation in the esophagus. Healthcare providers sometimes prescribe short-term systemic corticosteroids (pills or tablets) to reduce severe inflammation.
• Proton pump inhibitors (PPIs): PPIs are oral medications (pills or liquids) that calm stomach acid production. They help reduce acid reflux, control inflammation in the esophagus, and improve swallowing. 
• Biologics: Biologic medications (monoclonal antibodies), such as Dupixent (dupilumab) and Fasenra (benralizumab), control immune responses to reduce inflammation. 

Esophageal Dilation

Long-term inflammation can damage the tissue of the esophagus, causing scarring and narrowing. Healthcare providers may recommend esophageal dilation (widening) for people with severe difficulty swallowing, who often get food stuck in the throat, or who haven’t had success with other treatments.

Dilation is not a cure for EoE, but it can improve quality of life by widening the esophagus to allow food to pass easily from the mouth to the stomach.

To widen the esophagus, your healthcare provider will insert an endoscope into your mouth and down your esophagus. They will use a thin cylinder or balloon to gently stretch the narrowed areas of the esophagus. Esophageal dilation is a safe and effective procedure, and many people experience almost immediate relief from swallowing difficulties. 

While esophageal dilation addresses the structural effects of EoE, it does not treat the underlying inflammation. If new strictures (places of narrowing) develop, some people may require repeat procedures.

There is no known way to prevent eosinophilic esophagitis entirely. Certain dietary and lifestyle habits may reduce the frequency and severity of symptoms and prevent long-term complications. You can try the following: 

• Identify and avoid food triggers: Work with a healthcare provider to identify specific foods that trigger or worsen symptoms and eliminate them from your diet. 
• Manage environmental allergies: If you have environmental allergies, such as pollen or pet dander, limit your exposure to allergens that may contribute to EoE symptom flares. 
• Follow your treatment plan: Take medications as prescribed and get regular checkups from your healthcare provider. During the visits, they can monitor your symptoms and esophageal inflammation and adjust your treatment plan as needed.

People with eosinophilic esophagitis often have other allergic conditions, likely due to environmental and genetic factors and an overactive immune response. Commonly related conditions include: 

• Asthma: Up to 50% of people with EoE have asthma, a chronic condition that causes inflammation and narrowing of the airways, making breathing difficult.
• Atopic dermatitis (eczema): This inflammatory skin condition causes red, itchy, inflamed skin patches. About 18% of people with EoE may have eczema.
• Allergic rhinitis: You can develop this group of symptoms, such as runny nose, sneezing, and watery eyes, after being exposed to environmental allergens like pollen, dust mites, and pet dander. Up to 60% of people with EoE also have allergic rhinitis.
• Food allergies: Many people with EoE also have food allergies, which are often directly involved in triggering EoE symptoms.

Living with eosinophilic esophagitis can be difficult, but with proper management, you can have an active, fulfilling life. EoE does not affect life expectancy, but its symptoms and complications—like difficulty swallowing or food that gets stuck in your throat—require dietary adjustments and ongoing medical treatment.

If you struggle to swallow solid foods, simple accommodations, like eating smaller bites, thoroughly chewing food, and avoiding known triggers, can make swallowing easier.

Although there is no cure for EoE, advances in research are leading to promising new treatments, such as biologics targeting immune responses. If you or a loved one are living with EoE, many resources are available to help manage the condition and ensure you live a good quality of life.