Could You Have Eosinophilic Esophagitis? What You Need To Know

Medically reviewed by Todd Eisner, M.D.
Written by Emily Wagner, M.S.
Posted on September 29, 2022

  • Eosinophilic esophagitis (EoE) occurs when white blood cells called eosinophils build up in the esophagus and cause inflammation.
  • Symptoms of EoE vary by age but generally include difficulty swallowing, as well as vomiting and reflux.
  • Treatment options for managing symptoms include one therapy for EoE approved by the U.S. Food and Drug Administration (FDA).

Eosinophilic esophagitis is an inflammatory disease caused by an excess of immune cells, known as eosinophils, in the esophagus. According to the National Organization of Rare Disorders (NORD), this chronic condition affects around 1 in 2,000 people. People of any age can develop EoE, and having other allergic conditions increases your risk. Fortunately, several treatment options can both target EoE inflammation directly and manage symptoms of the condition.

What Is Eosinophilic Esophagitis?

EoE develops when an overactive immune system affects esophageal tissues. The immune system acts as the body’s first line of defense against invaders such as bacteria and viruses. However, in immune-related diseases such as EoE, the immune system can go into overdrive and begin harming the body’s healthy tissues as well.

In eosinophilic esophagitis, too many eosinophils — a specific type of white blood cell — build up in the esophagus (the tube that connects the mouth to the stomach). Eosinophils normally help fight infections by creating inflammation, trapping invaders, and releasing toxic substances to kill the invaders. However, with EoE, excess eosinophils in the esophagus create inflammation, damaging that part of the digestive system.

While researchers aren’t sure exactly what causes EoE, they believe the eosinophils are related to an allergic reaction to certain substances, such as:

  • Pollen
  • Mold
  • Dander (skin flakes from animals)
  • Dust mites
  • Common food allergens (substances that trigger an allergic reaction)

Exposure to these allergens while breathing or eating may set off a reaction, leading to EoE symptoms.

What Are the Symptoms of Eosinophilic Esophagitis?

Symptoms of eosinophilic esophagitis vary from person to person, especially across age groups and between pediatric and adult cases. Symptoms arise mainly as a result of inflammation in the esophagus, which leads to strictures or narrowing of the tube. This prevents food from moving down into the stomach, causing complications with eating and digestion.

For infants and young children, symptoms can include regurgitation (vomiting), difficulty feeding, reflux that doesn’t improve with medication, and problems with growth and weight gain.

For older children and adolescents, symptoms include abdominal pain, vomiting, dysphagia (difficulty swallowing), and reflux.

For adults, symptoms include dysphagia, food impaction (getting stuck in the esophagus), and chest pain from heartburn and reflux.

Who Is at Risk of Developing Eosinophilic Esophagitis?

Certain factors increase a person’s risk of developing eosinophilic esophagitis. Genetics play a large role in many diseases, including EoE. You’re more likely to develop the condition if you have a family member with EoE. Researchers have found that having certain genes that are related to eosinophil function can also increase the risk of EoE.

EoE can develop at any age in any person, but white males ages 30 to 40 are more likely to be diagnosed with the condition. Risk is also higher for those who have other immune-related or allergic conditions, including:

  • Atopic dermatitis (eczema)
  • Food allergies
  • Asthma
  • Environmental allergies, such as allergic rhinitis (seasonal allergies)

Recognizing the symptoms of EoE can help point your doctor toward a correct diagnosis.

How Is Eosinophilic Esophagitis Diagnosed?

If your doctor suspects that you have EoE, they will likely refer you to a gastroenterologist. This type of doctor specializes in diseases that affect the gastrointestinal system, including the esophagus, stomach, and intestines. Because EoE is an allergic condition as well, you may also be referred to an allergist for treatment.

Eosinophilic esophagitis usually becomes apparent because a person has difficulty swallowing. A gastroenterologist will perform an upper endoscopy to look for narrowing in the esophagus, which may also have multiple rings. A biopsy of the esophagus must be done to confirm the diagnosis, with the pathologist looking for increased eosinophils.

Blood Tests

If your allergist believes that a specific allergy is causing your EoE, they may do blood tests to check. These tests look for the antibody immunoglobulin E (IgE), which the body makes in response to a specific allergen. They may also check to see if you have higher-than-normal eosinophil counts.

Upper Endoscopy

To get a look at the esophagus and any inflammation or strictures, your gastroenterologist will perform an upper endoscopy. This procedure involves a long, thin tube with a camera attached to one end. The tube is inserted into the mouth and down the esophagus to provide a view of the tissues and take pictures.

Esophageal Biopsy

During an upper endoscopy, your gastroenterologist will take a tissue sample from the esophagus. Known as a biopsy, this technique can help determine whether you have EoE or another condition. The tissue sample is sent off to a lab, where another specialist physician called a pathologist looks at it under a microscope to count the number of eosinophils.

What Are the Treatments for Eosinophilic Esophagitis?

After you are given a diagnosis of EoE, your gastroenterologist will discuss your treatment options with you. Currently, just one therapy is approved by the FDA specifically for the treatment of EoE. Other nonspecific treatments also might help alleviate symptoms. Some treatments may work better than others, so it’s important to remember that this can involve some trial and error.

Dietary Therapy

For people whose EoE is caused by food allergies, eliminating certain allergens that trigger a response may help manage EoE. Doctors might have you try a few dietary strategies, including elimination and elemental diets. Although dietary treatments can be effective for EoE, they are restrictive and can make it difficult to maintain proper nutrition.

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are medications typically used to treat gastroesophageal reflux disease (GERD). They reduce the amount of acid the stomach makes, which can help alleviate EoE symptoms such as heartburn. Doctors often start with PPIs to treat EoE, but for many people, these drugs don’t relieve EoE symptoms.

Topical Steroids

Medications called steroids help control inflammation. In EoE, topical steroids are swallowed to act directly on the esophagus to help dampen inflammation. Budesonide (Entocort EC) is usually taken in a slurry — a liquid with a thickener, such as a sweetener to help it taste better. Fluticasone (Flovent), a powder, requires an inhaler.

Dupilumab

Dupilumab (Dupixent) is a biologic medication approved by the FDA for treating EoE in adults and children ages 12 and older. This human-made antibody works by blocking inflammation, treating the cause of EoE at its source. Dupixent is the first and only FDA-approved EoE treatment. In clinical trials — research studies to evaluate treatments — dupilumab successfully reduced EoE symptoms and helped participants achieve remission compared with a placebo.

Esophageal Dilation

If your esophagus is extremely narrow from strictures or topical steroids don’t work well enough on their own, your doctor may recommend esophageal dilation. This procedure opens the esophagus by stretching it out. While this method can help avoid use of topical steroids, it often needs to be repeated multiple times to be effective.

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.

Have you or a loved one been diagnosed with EoE? Do you have symptoms that you believe could be caused by EoE? Share your experiences in the comments below.

    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.

    Scott

    I think I have this I choke on certain foods blood work shows high white blood cells

    February 15, 2023

    Joan

    I do have this my EOS count is always very high. I had a barium swallow. was told throat size of baby finger should be size of thumb. Also had endoscopy and I asked Gastronif he stretched it but he said mine was not that kind it was one that needed surgery. I eat mostly soft meals, chew forever. I have 4vother autoimmune diease and so many allergies. So many. Allergic to drugs, food, sun, heat. Hot mess. Seeing my gastro in a month saved this to question him. I can drink tea and when I swallow sometimes it comes out my nose.

    February 25, 2023

    Nancy3

    I have gone gluten and dairy free.I also take allergy meds every day.I take diltiazem to help with keeping it open and panterozole.Sometimes I need to take Carafate.

    March 7, 2023

    Shannon2

    I am so uoset at the fact that I cant eat rice anymore. Everytime I do it gets stuck. I'm not checking but I feel like I am and drinking something just brings everything up. I want to find relief from this diagnosis, but I don't want to live my life dependent on a sterrhoid.

    March 7, 2023

    PATTI2

    I have been diagnosed with EoE. I have difficulty with rice and French fries. I have numerous allergies! I have been prescribed numerous meds. And I have had my esophagus dilated numerous times. I wish I could manage it better!

    March 7, 2023

    Encarnacion

    I have been diagnosed recently with EoE this month after endoscopy and treated with Butenoside swallowed but it didnot help me. Even though I do elimation diet and pureed all my foods, After 6 day,s my doctor swith me with methylprednisolone but still didnot hepledme. I doing drinking cold water no more tea but still I have the symptoms. I am losing weight 2 lbs. every week .crush all medication but to no avail. I wish I can do be help. I am miserable for almost a year. Is there a solution for this.

    March 16, 2023

    Abby

    I was just diagnosed with eoe o am in so much pain and nothing is helping. I'm losing weight,sleep and my sanity and my provider is no help all! And all my provider says Is I'm sorry don't know what to tell you and they just throw meds at me and they don't care. They told me plan on a feeding tube In 4 to 6 months if I'm lucky! I'm just over this!

    August 31

    Billie

    You need to get another provider. I was diagnosed several years ago. They told me to completely fix, tube feed is ideal, however you want to avoid that as long as possible. They can do allergy testing to help eliminate some irritants, there is medicine but it needs to be right. It does get really bad sometimes. Just please get a second opinion, I'm getting ready to have to go back and see my GI because I'm in a bad flare up experience the same as you.

    September 2

    Rebecca4

    Abby- get another opinion, I agree with Billie. I cut out all dairy, already limited glutens and I take Prilosec. I was very strict with everything and limited my sugar intake. I healed myself significantly in 6 months. It’s been 18 months now and I did really well all that time. Right now I am struggling but my seasonal allergies have kicked in and I was trying to eat dairy again these the last few months. I am going to cut all dairy out again. Good luck to you and don’t give up.

    September 2
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