6 Common Symptoms of Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis (EoE) occurs when white blood cells called eosinophils build up in the esophagus, the tube that moves food and liquids from the throat to the stomach. This buildup of eosinophils leads to inflammation, damaging the tube’s tissues and disrupting its function. 

The main symptom of EoE is difficulty swallowing. Other common symptoms can develop, too. The specific symptoms may vary by age.

EoE symptoms often develop gradually and worsen over time. People with EoE can develop symptoms within hours, days, or weeks after coming in contact with a food allergen. Environmental factors, like cold or dry weather and allergies (like pollen), can often trigger or worsen EoE symptoms. 

Here are the common symptoms you may have from EoE:

Dysphagia (difficulty swallowing) is the main symptom of eosinophilic esophagitis. An overload of eosinophils in the esophagus causes inflammation, leading the esophagus to swell or narrow. These changes can make it difficult for food and liquids to pass smoothly from the mouth to the stomach.

People with EoE may experience a sensation of food “sticking” in their throat or chest, especially with solid foods. They may also have pain or discomfort when swallowing. People often don’t recognize their symptoms as part of a medical condition. Instead, they may consider themselves slow eaters.

People with EoE often change their eating habits to make swallowing easier. They might avoid foods with certain textures and opt for softer, easier-to-swallow foods. Many people with EoE drink a lot of water or other drinks during meals to help with swallowing. They are also often the last to finish a meal.

Untreated EoE can eventually lead to more persistent or severe swallowing problems due to the formation of esophageal strictures (narrowing of the esophagus).

Food impaction is a painful sensation of food getting “stuck” in the throat or chest after swallowing. It occurs when food becomes lodged in the esophagus and can’t pass into the stomach. Inflammation causes the esophagus to narrow, making it harder for solid food to pass through to the stomach.

Food impaction is a common symptom of EoE, with up to 39% of adults with EoE having experienced it. 

The episodes can be frightening. People with food impaction may gag, vomit, or salivate excessively. A severe blockage can lead to difficulty breathing or speaking. If the food does not pass into the stomach or is not vomited up quickly, immediate medical care is needed.

Reflux is the backflow of stomach contents (acid and food) into the esophagus, and it’s a common EoE symptom. Reflux may feel like a burning sensation in your chest, neck, or throat. It may worsen after a meal, when bending over, or while lying down. Reflux may also cause a sour or bitter taste in your mouth. 

While EoE reflux can mimic gastroesophageal reflux disease (GERD), the inflammation in EoE-related reflux is due to an overactive immune response to food or environmental allergens rather than excessive stomach acid (as in GERD). This makes typical reflux treatments, like antacids, ineffective for managing EoE-related reflux.

Pain in your abdomen or chest can develop due to inflammation in your esophagus and the strain caused by difficult swallowing.

Some people experience burning chest pain or a squeezing sensation, which may be mistaken for a heart attack or other heart-related problems. Others may experience more generalized chest or upper abdominal discomfort after eating.

Long-term chest or abdominal pain with EoE can lead to reduced appetite, anxiety associated with eating, and weight loss over time. 

Regurgitation is the involuntary return of food or liquid to the throat or mouth after eating or drinking.

With EoE, regurgitation occurs because the esophagus becomes inflamed or narrowed, preventing the proper transport of food and liquids to the stomach. Food or fluids may remain stuck or move backward, leading to regurgitation.

This symptom can be distressing and uncomfortable. It can occur unpredictably, typically during or shortly after meals.

Sleep problems are common in people with eosinophilic esophagitis. Around 50% of adolescents and 63% of adults with EoE have trouble falling or staying asleep because of their symptoms, particularly heartburn and chest or abdominal pain.

Among those experiencing sleep disturbances, the issues are often frequent. About 60% of people say they have trouble falling asleep all or most of the time. Waking up multiple times during the night is another common issue for people with EoE.

These disruptions can lead to poor sleep quality, impacting daytime energy levels, mood, and overall quality of life.

Eosinophilic esophagitis can affect people of all ages, including infants and children. It’s estimated that out of every 100,000 children in the United States, 34 have EoE. Symptoms in children can vary depending on age. 

Symptoms in Infants

EoE symptoms in infants and younger can include: 

• Feeding difficulties or refusal to eat
• Vomiting or spitting up frequently
• Arching their back when vomiting or spitting up (a sign of pain)
• Poor weight gain or growth 
• Irritability, especially during or after feeding
• Coughing while feeding 

Symptoms in Older Children

EoE symptoms may wrongly be linked to picky eating or other gastrointestinal problems as children grow. Common EoE symptoms in children can include: 

• Difficulty swallowing; a sensation of food “sticking” in their throat
• Abdominal pain that returns again and again
• Nausea and vomiting
• Poor growth or weight gain
• Refusal to eat specific foods or textures
• Heartburn that doesn’t go away with acid-reducing medications
• A feeling of fullness after eating small amounts of food

Many people with EoE have symptoms for years before seeking medical care. Early diagnosis and treatment can help prevent complications, so it’s important to seek medical attention if you develop persistent EoE symptoms, such as:

• Difficulty swallowing that is ongoing or worsening
• Heartburn or reflux that does not improve with standard medications
• Frequent regurgitation or vomiting, especially after eating
• Unexplained chest or abdominal pain
• Strong dislike or avoidance of certain foods, particularly in children
• Poor weight gain or growth in children

Food impaction can be an emergency that requires immediate medical attention. Call 911 if you or a loved one develop any of the following symptoms when food gets stuck in your esophagus: 

• A lot of salivation or drooling 
• A feeling of pressure or fullness in the chest
• Saliva that appears bloody
• Gagging or choking
• Difficulty breathing or hyperventilation (rapid breathing) 

Eosinophilic esophagitis (EoE) causes inflammation in the esophagus, leading to difficulty swallowing, chest pain, heartburn, and regurgitation. Long-term inflammation can narrow the esophagus, increasing the risk of food getting stuck in the throat.

Some EoE symptoms vary by age. Children are more likely to experience nausea, vomiting, and abdominal pain, while adults are more likely to experience heartburn and chest pain.

Early diagnosis and treatment can help prevent complications and improve quality of life. If you or a loved one experiences EoE symptoms, see a healthcare provider to discuss your concerns and next steps.