Eosinophilic Esophagitis
Also known as: EoE, Allergic esophagitis
Eosinophilic esophagitis, often shortened to EoE, is a chronic allergic condition in which a type of white blood cell called an eosinophil builds up in the lining of the esophagus. These cells cause inflammation that, over time, makes the esophagus stiff and narrow, so food can get stuck and swallowing becomes difficult. It is usually triggered by food allergens, most often milk, wheat, egg, soy, nuts, and seafood, and it commonly occurs in people who also have asthma, eczema, or hay fever. Once considered rare, it is now a leading cause of food impaction in young adults and feeding difficulties in children. Treatment with diet changes, acid suppression, swallowed steroids, or newer biologic medications controls the inflammation in most people.
At a Glance
- Common symptoms
- Difficulty swallowing, especially solid foods such as meat and bread, Food becoming stuck in the esophagus (food impaction), Chest pain or heartburn that does not improve with standard reflux medication
- Main treatments
- Proton pump inhibitors, which reduce inflammation in a substantial proportion of people, Swallowed topical steroids (fluticasone or budesonide) formulated to coat the esophagus, Dupilumab, a biologic injection approved for eosinophilic esophagitis in older children and adults
- Category
- Digestive · Increasingly diagnosed; a leading cause of food impaction in young adults and feeding problems in children
- See a doctor if
- Food becomes stuck and will not go down or come up, especially with drooling or chest pain (emergency)
Symptoms
Causes
- An immune reaction to food allergens that causes eosinophils to accumulate in the esophageal lining
- Airborne allergens such as pollen, which may worsen symptoms seasonally in some people
- Genetic susceptibility, as the condition runs in families
- Chronic inflammation leading to scarring (fibrosis) and narrowing of the esophagus over time
Risk Factors
- Male sex; the condition is several times more common in males
- A personal history of asthma, eczema, hay fever, or food allergies
- A family history of eosinophilic esophagitis
- Living in a cold or dry climate, and being born by cesarean or receiving antibiotics in infancy (proposed associations)
- Diagnosis most often in children and adults under 50
Diagnosis
- A history of swallowing difficulty, food impaction, or feeding problems, especially with allergic conditions
- Upper endoscopy, which may show rings, furrows, white plaques, or narrowing in the esophagus
- Biopsies showing a high count of eosinophils in the esophageal lining, which is required for diagnosis
- Exclusion of other causes of eosinophils in the esophagus, such as reflux or infection
- Allergy testing in some cases, though it is not reliable for identifying the trigger foods
Treatment
- Proton pump inhibitors, which reduce inflammation in a substantial proportion of people
- Swallowed topical steroids (fluticasone or budesonide) formulated to coat the esophagus
- Dupilumab, a biologic injection approved for eosinophilic esophagitis in older children and adults
- Endoscopic dilation to stretch narrowed areas and relieve food sticking
- Elimination diets, most commonly removing dairy first, or a six-food elimination diet with supervised reintroduction
- Supportive: working with a dietitian to keep nutrition adequate during any elimination diet, especially in children
- Supportive: eating slowly, cutting food small, and chewing thoroughly to reduce the risk of impaction
Prevention
- The condition cannot be prevented, but flares and complications can be reduced
- Take maintenance treatment consistently, since inflammation returns when treatment stops
- Avoid identified trigger foods
- Keep up with follow-up endoscopies as recommended to confirm the inflammation is controlled
- Manage coexisting asthma and allergic conditions
When to See a Doctor
- Food becomes stuck and will not go down or come up, especially with drooling or chest pain (emergency)
- Recurrent difficulty swallowing or needing to avoid certain food textures
- Heartburn or chest pain that does not improve with over-the-counter reflux treatment
- A child who refuses food, vomits frequently, or is not gaining weight
- Symptoms returning after stopping treatment
Frequently Asked Questions
Related Conditions
Have questions about Eosinophilic Esophagitis?
Ask Mother Nature AI for personalized, evidence-based guidance.
Ask about Eosinophilic EsophagitisMedical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.
Content reviewed against peer-reviewed medical literature and clinical guidelines. Read our editorial standards.