• Gluten is a protein frequently found in foods that contain grains, including baked goods and processed foods.
• Currently, there is little evidence that celiac disease — a condition in which the immune system reacts poorly to gluten — is linked to eosinophilic esophagitis (EoE).
• Different foods may provoke EoE symptoms in different people, but so far research hasn’t found that gluten is a common trigger

EoE occurs when white blood cells called eosinophils build up in the esophagus (the tube that connects the mouth to the stomach). This abnormal immune response can be brought about by food, acid from the stomach, or an allergen (a substance you’re allergic to). The disorder leads to swallowing difficulties, chest pain, acid reflux, and gastrointestinal symptoms.

EoE is often linked to common allergens such as wheat, dairy, soy, egg, peanuts, tree nuts, fish, and shellfish. For some people with the condition, eating these foods may make EoE worse.

It’s also possible that eating gluten can bring on EoE symptoms, although this likely isn’t the case for most people. Although the relationship isn’t yet fully clear, researchers are working to determine whether gluten is linked to EoE.

What Is Gluten?

Gluten is a protein found in several types of grains, such as:

• Wheat, including varieties like farro, semolina, spelt, and durum
• Rye
• Barley
• Triticale, a hybrid of wheat and rye

Some people who avoid gluten also stay away from oats. Oats may be contaminated with gluten when they come into contact with gluten-containing products, whether in the field, during transport, or in processing facilities.

Gluten-containing grains are commonly found in foods like bread, baked goods, pasta, cereal, and beer. This protein can also pop up in other processed foods, including gravy, soup, lunch meat, meat substitutes, seasonings, sauces, and salad dressings.

Celiac Disease and Gluten Intolerance

For most people, consuming gluten isn’t harmful and doesn’t cause health issues. However, some people don’t eat gluten because their body can’t tolerate it.

Celiac disease is an autoimmune disease usually caused by certain gene mutations. When a person with celiac disease eats gluten, their immune system perceives the protein as an invader and attempts to destroy it. This leads to damage to the inner lining of the small intestine. Over time, this damage can make it harder for the intestines to absorb the nutrients needed to stay healthy.

Celiac disease can lead to symptoms like:

• Abdominal pain or bloating
• Excess gas
• Diarrhea or constipation
• Tiredness
• Pale skin
• Headaches
• Mouth sores
• Unexpected weight loss
• Muscle weakness
• Infertility

Some people who don’t have celiac disease still have difficulty eating gluten. This condition, called gluten intolerance, can lead to many of the same symptoms as celiac disease, even though it’s not caused by the same immune system reactions.

The treatment for both celiac disease and gluten intolerance is a gluten-free diet.

EoE and Celiac Disease

Both EoE and celiac disease are conditions in which the immune system is abnormally triggered by specific foods. This has led some researchers to wonder whether there is a link between the two.

Is EoE More Likely in Children Who Have Celiac Disease?

Researchers first suggested a potential connection between pediatric EoE and celiac disease based on the results of multiple studies. EoE affects just 0.05 to 0.1 percent of children in the United States, according to a 2018 study in Clinical Reviews in Allergy & Immunology. However, findings of two studies in Illinois and Michigan showed that a higher percentage of children with celiac disease — an estimated 6.3 percent and 10.7 percent, respectively — have EoE.

However, not all research has backed up these findings. A study of more than 10,000 children who’d had an endoscopy (a procedure to examine the digestive tract) found that nearly 6 percent had EoE, but less than 2 percent of those with celiac disease also had EoE. In other words, kids who had one disease weren’t more likely to have the other too.

Is There a Connection in Adults?

Recent studies haven’t found a link between EoE and celiac disease in adults either. In one small study looking for an association, researchers concluded that the genetic mutations causing celiac disease occurred at about the same rate whether or not people had EoE. Other researchers also haven’t found that people with one condition are more likely to get the other.

These findings led some health experts to wonder if it’s simply a coincidence that some people get both conditions — the pattern of inflammation in the two diseases is different.

Even if an association does exist, the relationship between the two diseases remains unclear. Experts don’t know if EoE may lead to celiac disease, if celiac disease can cause EoE, or if some additional factor may increase the risk of both conditions.

Future research may shed some light on a possible connection. Many doctors became aware of EoE only in the past couple of decades, so this condition hasn’t been studied for very long.

Additionally, because neither EoE nor celiac disease affects many people, it’s difficult to find enough people in which to study both conditions together.

Furthermore, researchers often use different methods to diagnose the two conditions, making it hard to compare results between studies. Additional research may help us confirm or rule out a relationship between celiac disease and EoE.

Does Gluten Affect EoE?

Some people with EoE feel that gluten worsens their symptoms. However, triggers of EoE symptoms vary widely — foods that cause inflammation for some people don’t cause any issues for others. Gluten won’t be a problem for everyone with the condition.

In a study of people diagnosed with both EoE and celiac disease, about one-third of them experienced fewer EoE symptoms after switching to a gluten-free diet. This diet also seems to help children who have both conditions.

It’s possible that gluten may be responsible for EoE in people who don’t have celiac disease. However, these cases seem to be extremely rare.

Gluten-free diets may help certain people with EoE, although not enough research has been done to know for sure. Wheat, which contains gluten, commonly causes an allergic response in people with EoE, so it’s possible that gluten-free diets may help simply by eliminating this grain.

If you find that eliminating wheat or other gluten-containing foods eases your symptoms even if you don’t have celiac disease, then continue to follow the dietary pattern that works best for you.

Talking to Your Doctor About Your Diet

If you’re living with EoE and you feel like your symptoms aren’t under control, work with your doctor to explore your treatment options. Your health care team can help you find diets, medications, procedures, or other therapies that can help.

When talking to your doctor about your condition, mention all your symptoms and estimate how long you’ve had them. Additionally, make sure your doctor knows about any health conditions you have, including celiac disease, food allergies, or asthma. If your provider recommends any additional treatments, ask about the potential benefits and risks.

You also may want to ask your doctor if they believe gluten, wheat, or other foods may be contributing to your EoE. If you suspect that your symptoms are connected to gluten, you may also want to ask about allergy testing or having your blood tested for celiac disease.

Getting Advice About Dietary Therapy

It’s important to get expert advice before you make dietary changes, because following a gluten-free diet comes with certain risks.

Many foods that contain gluten also have important nutrients that help you stay healthy. For example, whole-grain foods contain a lot of fiber, which supports healthy digestion and may reduce your risk of developing a chronic condition such as heart disease. Additionally, many common foods that have gluten — including bread, cereal, and pasta — are fortified with extra vitamins. If you cut out gluten, you’ll need to make sure you’re getting enough of these nutrients from other sources.

Some gluten-free products are also highly processed and contain extra salt, sugar, or additives. Eating a lot of these products could negatively affect your health.

If your doctor suggests changing your diet, ask for a referral to a registered dietitian. These health care professionals can help you adjust your eating plan in a safe way that ensures all your nutritional needs are met.

Talk With Others Who Understand

On myEoEcenter, the website for people with eosinophilic esophagitis and their loved ones, you can gain a new understanding of EoE and share your story with others who understand life with EoE.

Do you eat gluten? Do you feel like it has an impact on your eosinophilic esophagitis? Share your experience in the comments below.