GERD vs. EoE: Differences in Treatment

Eosinophilic esophagitis (EoE) is a chronic immune condition that develops when a specific type of white blood cell — called an eosinophil — builds up in the esophagus. The esophagus is the tube in your throat that connects your mouth and stomach. As a result, the esophagus becomes inflamed and causes reactions to allergens and foods, or acid reflux.

Gastroesophageal reflux disease (GERD), on the other hand, is a digestive system condition caused by stomach acid entering the esophagus. This results in acid reflux, or heartburn, that occurs at least a couple of times per week.

Since GERD can have many of the same symptoms as EoE, they’re often confused with one another. Although doctors may recommend diet changes for both conditions, the treatments for GERD and EoE are otherwise very different.

How Are Eosinophilic Esophagitis and GERD Diagnosed?

Since symptoms of EoE and GERD are similar, making an accurate diagnosis of one or the other can be difficult. These symptoms include:

• Trouble swallowing, known as dysphagia
• Chest or abdominal pain, mainly caused by heartburn
• Backwash of undigested food, called regurgitation

People with EoE usually have difficulty swallowing. They might also experience food impaction, which occurs when food becomes stuck in the esophagus after swallowing.​

The main symptom of GERD is heartburn. With chronic heartburn, narrowing of the esophagus can lead to difficulty swallowing.

Both EoE and GERD can be diagnosed with an upper gastrointestinal (GI) endoscopy. In this procedure, a thin, flexible tube with a camera and light attached to the end is led down the esophagus. This procedure helps doctors look for signs of these two conditions.

For people with EoE, the esophagus will develop scar tissue or become narrow (known as a stricture), while GERD causes inflammation, scarring, and bleeding from stomach acid. It can be difficult to tell the difference, and a doctor may diagnose GERD instead of EoE.

How Can You Tell the Difference Between GERD and EoE?

During the upper endoscopy, the doctor will take a small piece of tissue called an esophageal biopsy. A pathologist will look at the tissue under a microscope. If eosinophils are found in the biopsy tissue, the test can confirm a diagnosis of EoE.

While EoE and GERD have similar symptoms, effective treatments vary between the two conditions. Some treatments that work for GERD may not always be effective for EoE.

First-Line Treatments for GERD

GERD is caused by stomach acid entering the esophagus, leading to heartburn and potential tissue damage. Healthcare providers usually suggest making lifestyle changes and trying nonprescription medication as a first step for treatment. If these don’t work, prescription medication can be tried. Here are some common treatment options for GERD.

Lifestyle and Dietary Changes

Your healthcare provider will likely suggest some of the following guidelines for reducing your GERD symptoms:

• Identify food triggers that make your GERD worse, and try avoiding them. Examples include spicy food, fried food, and coffee.
• Avoid eating right before bed.
• If you’re living with overweight or obesity, consider losing weight if your doctor advises it. Weight loss has been shown to improve GERD symptoms.
• If you smoke, try quitting.
• If you have symptoms during sleep, try to elevate your head 45 degrees.

Nonprescription Medications

There are three categories of nonprescription drugs that can help with GERD symptoms. These are:

• Antacids — Chewable tablets or liquids that neutralize stomach acid
• Histamine (H-2) blockers — Medications that reduce stomach acid production
• Proton pump inhibitors (PPIs) — Drugs that are stronger than H-2 blockers and also reduce stomach acid

Prescription Medications

If lifestyle changes and nonprescription drugs aren’t helping, there are prescription medication options for GERD. These include prescription-strength PPIs and H-2 blockers. There’s also a new category of prescription drug called potassium-competitive acid blockers (PCABs), which is sometimes used for severe GERD if other medications aren’t working.

Treatments for EoE

Treatments for EoE can include dietary changes for food allergies, medication, and procedures. Since EoE is a chronic immune condition, these treatments may be ongoing to help manage symptoms and control flares.

PPIs are also used as a first-line treatment for EoE to reduce inflammation in the esophagus. However, PPIs do not work for everyone. In this case, other treatment options will be suggested.

Dietary Changes

Your healthcare provider may want you to see an allergist to see if you have any food allergens contributing to EoE. Recommended dietary changes may include eliminating any foods that trigger an allergic reaction, such as dairy, wheat, eggs, and soy.

Dietary therapy may have fewer side effects than taking medications or receiving endoscopic treatments. However, getting the nutrition you need could be difficult if you’re on an elimination diet that restricts large food groups, like wheat and dairy products. Your doctor or a dietitian can help you design a balanced diet.

Dupilumab

Currently, there are only two medications approved by the U.S. Food and Drug Administration (FDA) specifically for treating EoE. Dupilumab (Dupixent) is approved to treat EoE in adults and children aged 1 year and up. It’s a type of medication called a monoclonal antibody. Dupilumab works by blocking inflammatory processes in the esophagus. It’s given by injection once a week.

Topical Steroids

The second FDA-approved medication for treating EoE is a topical corticosteroid called budesonide (Eohilia). This medication comes in liquid form and is taken by mouth. This steroid comes in contact with the inside of the esophagus and reduces inflammation. Another commonly prescribed steroid for treating EoE is fluticasone, although it’s not specifically approved for use in EoE. Fluticasone is sprayed into the mouth using an inhaler and swallowed.

While steroids may help treat EoE symptoms, they’re not helpful for GERD. Moreover, certain steroids may actually worsen heartburn in some people.

Endoscopic Treatments for EoE

Endoscopy procedures can also be used to treat symptoms and complications of EoE.

Endoscopy for Food Impaction

Between 33 percent and 55 percent of children and adults with EoE experience food impaction. This is when food becomes stuck in the esophagus, preventing it from moving into the stomach. Food impaction can be a medical emergency, and removal requires an endoscopy with specialized tools.

Endoscopy for Strictures

Adults and children with EoE can develop strictures of the esophagus because of inflammation and scarring. Strictures can make it hard to swallow. To help widen these strictures, the esophagus can be dilated using endoscopy. Dilation endoscopy is usually only used if medications are not working because there is a risk of esophagus damage and chest pain. It often takes several sessions of endoscopy to open the esophagus wide enough to make a difference.

Which Treatment Option Is Right for You?

EoE is a complex disease that can be difficult to treat. Talk to a healthcare provider who specializes in gastroenterology (study of the digestive system) about your options and which may work best for you. Each case of EoE is unique, so it’s important to work with your doctor to find which treatments are most effective.​

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Did your doctor initially suspect you or your child had GERD before you received an EoE diagnosis? Let others know in the comments below.