Could It Be EoE? Eosinophilic Esophagitis Symptoms

Medically reviewed by Todd Eisner, M.D.
Written by Emily Wagner, M.S.
Posted on September 26, 2022

  • Eosinophilic esophagitis (EoE) symptoms are caused by inflammation and narrowing of the esophagus, which makes eating and swallowing difficult.
  • Symptoms of EoE vary by age group, with different symptoms occurring in infants, children, adolescents, and adults.
  • Knowing the symptoms of EoE may help ensure you receive a correct diagnosis and begin effective treatments as soon as possible.

Eosinophilic esophagitis is a chronic immune condition that results in inflammation of the esophagus. This inflammation is caused by an excess of immune cells, known as eosinophils, in the esophageal tissues. This leads to symptoms such as dysphagia (difficulty swallowing), food impaction (food getting stuck in the esophagus), and reflux (stomach acids entering the esophagus). EoE can affect infants, children, and adults. Symptoms can present differently among age groups, making the condition difficult to diagnose.

    Oftentimes, EoE is misdiagnosed as gastroesophageal reflux disease (GERD) before it’s correctly diagnosed as EoE. Knowing the symptoms of EoE can help point your doctor to a correct diagnosis so you can start effective treatments.

    What Causes Eosinophilic Esophagitis Symptoms?

    EoE is an inflammatory condition caused by a specialized type of white blood cell known as an eosinophil. Eosinophils play an important role in the immune system: They release chemicals to help fight off harmful organisms like parasites. These cells move to areas of inflammation to help other immune cells trap and kill invaders. Although eosinophils are generally beneficial, they’re also responsible for causing allergy and EoE symptoms.

    People living with EoE have higher levels of eosinophils in their bloodstream and esophagus, compared to those without the condition. When eosinophils become overactivated or too numerous, they release too many chemicals into the bloodstream, which activates immune cells. This brings in more cells and creates too much inflammation, which can damage the body’s healthy tissues.

    Allergies to substances such as pollen, pet dander, or certain foods can trigger this reaction. When you eat food or inhale air that contains an allergen, it comes in contact with the esophagus. The tissues in the esophagus then become inflamed. This inflammation can eventually cause the esophagus to narrow. This, in turn, can cause symptoms such as food impaction or swallowing difficulties.

    Symptoms of Eosinophilic Esophagitis

    Symptoms of EoE are mainly caused by narrowing of the esophagus from inflammation. Also known as a stricture, this narrowing is associated with rings forming in the esophagus, which make it more difficult for food to travel down into the stomach. In some cases, tissue that lines the esophagus can tear, especially in situations where food gets stuck.

    Age plays a large role in what symptoms occur in EoE cases.

    EoE Symptoms in Infants, Children, and Adolescents

    Pediatric cases of EoE look different than those in adults. In many cases, getting an infant or young child who’s diagnosed with EoE to eat can be difficult. This may result in a medical condition known as failure to thrive, which means a child isn’t getting enough nutrients to gain weight and grow. A child may lose weight as a result. Some younger children with EoE may also be extra sensitive to certain foods or textures, making it difficult for them to eat.

    Children and teenagers may also experience:

    • Dysphagia (trouble swallowing)
    • Nausea
    • Vomiting
    • Abdominal pain

    These symptoms make eating food — especially solid food — and keeping it down difficult. Food can get stuck in a person’s esophagus. This food impaction can be dangerous if the food isn’t vomited up. If left untreated, it can become a medical emergency.

    Infants and children of all ages may experience reflux, where stomach acid enters the esophagus. This may cause a burning sensation or warmth in the chest and neck area. A doctor may misdiagnose these symptoms as GERD and prescribe treatment with proton pump inhibitors (PPIs). Although PPIs can sometimes successfully treat EoE, they also sometimes fail and symptoms will continue. The ongoing symptoms may cause a doctor to re-evaluate their original GERD diagnosis and could eventually lead to a correct EoE diagnosis.

    EoE Symptoms in Adults

    Adults share some symptoms of EoE with younger people, but they also have a few distinct symptoms. Similar symptoms include:

    • Dysphagia
    • Food impaction, especially with solid, dry foods that are difficult to swallow
    • Stomach pain
    • Vomiting

    Additionally, adults can experience more intense acid reflux than children, which causes heartburn and pain in the center of the chest.

    Adults with EoE rarely show signs of failure to thrive or weight loss. Loss of appetite and disinterest in eating are also less common.

    If you notice you’re experiencing EoE symptoms several times a week or if they’re severe, talk to your doctor. If you take heartburn medications frequently, tell your doctor, as it may point them to an EoE diagnosis.

    Other Conditions Associated With Eosinophilic Esophagitis

    People with EoE often have other related health conditions which involve overactivation of the immune system. Examples include atopic dermatitis (eczema), asthma, and other food or environmental allergies. If you’re diagnosed with one or more of these health issues, you may be at a higher risk of having EoE. Not everyone with EoE has one of these other conditions, but between 50 percent and 80 percent do.

    Seasonal and food allergies are both connected to EoE. Some people may even notice their EoE symptoms worsen during allergy season or after eating certain foods. This is because eosinophils are directly involved in both conditions. An allergist may offer allergy testing, such as skin or blood tests, to determine which substances cause a reaction.

    Eczema and asthma also may involve an excess of eosinophils. People living with eczema may have too many eosinophils in their bloodstream and skin. In asthma, there can be too many of them in the bloodstream and lungs after a flare. Having too many eosinophils can affect other parts of the gastrointestinal system, including the intestines and stomach.

    Talk to Your Doctor About Your Symptoms

    If you’re experiencing any of the symptoms of EoE, talk to your doctor. They may perform tests and refer you to specialists to help accurately diagnose your condition. Typically, a gastroenterologist or an allergist helps diagnose EoE. Talking to your doctor is the first step in getting the treatment you need.

    To help correctly diagnose EoE, these doctors may run some tests to help rule out other conditions and confirm a diagnosis. These include an upper endoscopy and a biopsy. An upper endoscopy involves taking pictures of the esophagus with a small camera so that the specialist can see what is happening inside. A biopsy involves taking tissue samples, which a health care worker will view under a microscope to count the number of eosinophils present.

    Although there’s no cure for EoE, many treatment options are available to help target inflammation at its source and address symptoms. Treatment options that help alleviate symptoms of EoE include:

    Currently, dupilumab (Dupixent) is the only medication approved by the U.S. Food and Drug Administration (FDA) specifically for treating EoE. This drug works by directly targeting the inflammation created by eosinophils in the esophagus to help alleviate symptoms and treat the condition.

    Find Your Team

    On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to learn more about EoE and share their stories with others who understand life with EoE.

    What symptoms have you or a loved one experienced while living with EoE? Share your experiences in the comments below.

    Posted on September 26, 2022

    A myEoEcenter Subscriber

    My adult daughter has been diagnosed with EoE. She also develops itchy bumps periodically on her hands and other parts of her body. Anyone else have this situation? Any advice on treatment? Thank you

    posted October 13, 2022

    A myEoEcenter Subscriber

    I was recently hospitalized for vomiting up dark blood. Stomach had blood in it. 4 days of scopes and test produced no reason for this. I had 2 blood transfusions. Anyone expierence this.

    posted December 11, 2022

    A myEoEcenter Subscriber

    I haven't been diagnosed, but I'm sure I have EoE. I'm 81, 5'1" and 115lbs., take no prescriptions. I have food allergies,seasonal allergies and asthma. For a few years I've noticed my throat spasms while trying to eat certain foods and I usually have to go vomit. It's now gotten to the point where I can't eat any meat!! I do fine with fish. My doctor recently retired and her Nurse Practitioner didn't seem interested in my problem. I'll try to find a Gastroenterologist.
    So happy to have found this site.

    posted December 11, 2022


    So nice to see this article. I have a granddaughter with EOE. Glad this info is getting out.

    posted December 16, 2022


    I have recently been diagnosed with EOE. I am 60 years old and also have Crohns. My mother and her 2 brothers all have had swallowing issues and requisite dilations to treat. i also had asthma as a child, so this article is really hitting all of the marks for me. I am on Humira for the Crohns. Would Dupixent play well with Humira if they were both prescribed? My gastro didn't recommend least not for now. We're going down the allergist route to determine, what, if anything, I am allergic to.

    posted January 13, 2023


    My mom and I have been talking about this for years how my grandparents had to eat everything mushy and drink water with everything or they'd gag on it. No I'm having that issue with a lot of foods that I can sit and chew it until it's paste but I can't swallow it or I gag. I have no issues with drinking at if it's liquid but thick substances. I have had crohns disease for 1u years, psoriasis all my life and I've had asthma most of my life. This EoE fits so much.

    posted January 13, 2023


    I believe I have it. It is more pronounced when I sleep on my back at night. Years ago as a young man Dr Trooper did the camera test and suggested I raise the head of my bed 6 inches Didn't help much

    posted January 14, 2023


    I am being tested for this. As I look at the symptoms, I see I could have been dealing with this for quite some time. I have Hypothyroid, Hashimotos, and now I believe the breathing issue. Gut issues and Dysphagia/odynophagia.

    posted February 5, 2023
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    Todd Eisner, M.D. has 32 years of experience in gastroenterology and internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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