GERD vs. EoE: Differences in Treatment

Medically reviewed by Todd Eisner, M.D.
Written by Emily Wagner, M.S.
Posted on July 28, 2022

  • Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) have similar symptoms. Both are diagnosed with upper endoscopy.
  • Proton pump inhibitors (PPIs) can be used to treat both GERD and EoE.
  • Biologic medications and steroids are used to treat EoE, but not GERD.

Eosinophilic esophagitis is a chronic immune condition that develops when a specific type of white blood cell — known as an eosinophil — builds up in the esophagus. As a result, the esophagus becomes inflamed and causes reactions to allergens, foods, or acid reflux.

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

Since EoE and GERD have many of the same symptoms, they are often confused with one another. The methods of diagnosing these conditions and their treatments are similar as well.

How Are Eosinophilic Esophagitis and GERD Diagnosed?

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

  • Trouble swallowing, known as dysphagia
  • Chest or abdominal pain, primarily caused by heartburn
  • Regurgitation of undigested food

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 longstanding heartburn, narrowing or strictures 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 placed down into the esophagus. This helps doctors look for any abnormalities.

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

To help differentiate between the two conditions, the doctor will also take a small piece of tissue during the upper endoscopy for an esophageal biopsy. A pathologist will look at the tissue under a microscope. The presence of eosinophils 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. The main goal of treating GERD is to lower the amount of stomach acid produced or block its effects.

Proton Pump Inhibitors

The most common first-line treatment for GERD is proton pump inhibitors. These drugs work by limiting the amount of acid produced by the lining of the stomach, which can help alleviate GERD symptoms. PPIs are available over the counter or by prescription. Examples include:

  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)
  • Pantoprazole (Protonix)

PPIs are also used as a first-line treatment for EoE to reduce inflammation in the esophagus, often taken twice a day. However, because EoE is inherently an allergic condition caused by an overactive immune system, PPIs may not improve symptoms for some people.


Antacids are typically chewable tablets that neutralize stomach acid to help alleviate symptoms. These do not reduce the amount of stomach acid your body makes.

H2 Blockers

Similar to PPIs, H2 blockers also reduce stomach acid production to help treat GERD. Examples include famotidine (Pepcid or Zantac) and nizatidine (Axid).

Treatments for EoE

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

Dietary Changes

Your physician may want you to see an allergist to determine if you have any food allergies contributing to EoE. Recommended dietary changes may include eliminating any foods that trigger an allergic reaction.

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 restricted from several large food groups, like wheat and dairy products. Your doctor or a dietitian can help you design a balanced diet.


Currently, the only medication approved by the U.S. Food and Drug Administration (FDA) specifically for treating EoE is the biologic Dupixent, a formulation of dupilumab. Approved in May 2022, Dupixent is used to treat EoE in adults and children ages 12 and up who weigh at least 88 pounds. This medication works by limiting inflammation in the esophagus, alleviating EoE symptoms.

In EoE, eosinophils found in the esophagus release inflammatory mediators known as cytokines. Biologic therapies target eosinophils, other immune cells that interact with them, or the cytokines they release. This category of medications has a lot of potential to treat EoE, but biologics are not approved to treat GERD.


While there is only one FDA-approved medication for treating EoE, other medications are prescribed off-label for treatment. Topical steroids are often used as a first-line treatment in favor of dietary therapy, specifically because diet changes may require multiple endoscopies over a short amount of time to assess how effective they are.

The two most commonly prescribed topical steroids for treating EoE are fluticasone and budesonide. These corticosteroids help reduce inflammation in the esophagus and may alleviate swallowing difficulties in as quickly as a few days.

Topical steroids can be either drunk as a liquid or placed in the mouth using an inhaler and then swallowed. Budesonide is given orally but has a bitter taste, so many people mix it into a smoothie with sweeteners such as honey or syrups. Fluticasone is placed in the mouth by using an inhaler twice daily.

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

Endoscopic Procedures

Endoscopy is useful for diagnosing EoE, but it can also be used to treat symptoms of the condition.

Food Impaction

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


Adults and children with EoE can develop strictures in the esophagus. This occurs when the esophagus narrows, mainly due to inflammation and fibrosis. Fibrosis develops as a result of chronic inflammation, where the healing process replaces the cells that line the esophagus with collagen. As a result, the esophagus becomes scarred, thicker, and less flexible, leading to difficulty swallowing and, potentially, food becoming stuck.

To help widen these strictures, the esophagus can be dilated during an endoscopy. This dilation is done using wire dilators or balloons to widen the opening.

Which Treatment Option Is Right for You?

EoE is a complex disease that can be difficult to treat. Talk to a health care provider who specializes in gastroenterology about your options and which may work best for you. Some treatments, such as PPIs (which are also used for GERD), may not be as effective for you as for others. Each case of EoE is unique, so it’s important to work with your doctor to find which treatments are most effective.

Talk With Others Who Understand

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

Were you misdiagnosed with GERD before EoE? What treatments have you tried for eosinophilic esophagitis? Share your experience in the comments below.

  1. Eosinophilic Esophagitis — Mayo Clinic
  2. Gastroesophageal Reflux Disease (GERD) — Mayo Clinic
  3. Distinguishing GERD From Eosinophilic Oesophagitis: Concepts and Controversies — Nature Reviews Gastroenterology & Hepatology
  4. Eosinophilic Esophagitis — American Academy of Allergy Asthma & Immunology
  5. Diagnosis of GER & GERD — National Institute of Diabetes and Digestive and Kidney Diseases
  6. Upper GI Endoscopy — National Institute of Diabetes and Digestive and Kidney Diseases
  7. Eosinophilic Esophagitis: A Mimic of Gastroesophageal Reflux Disease — American Family Physician
  8. Proton Pump Inhibitors — MedlinePlus
  9. Taking Antacids — Medline Plus
  10. H2 Blockers — MedlinePlus
  11. Use of Dietary Strategies In Treating Eosinophilic Esophagitis — Mayo Clinic
  12. FDA Approves First Treatment For Eosinophilic Esophagitis, a Chronic Immune Disorder — U.S. Food and Drug Administration
  13. Controversies in Allergy: The Potential Role of Biologics as First-Line Therapy in Eosinophilic Disorders — The Journal Of Allergy and Clinical Immunology: In Practice
  14. Understanding Unapproved Use of Approved Drugs “Off Label” — U.S. Food and Drug Administration
  15. Topical Steroid Therapy for Eosinophilic Esophagitis — Gastroenterology & Hepatology
  16. Treatment of Eosinophilic Esophagitis With Swallowed Topical Corticosteroids — World Journal of Gastroenterology
  17. Prednisone (Oral Route) — Mayo Clinic
  18. Endoscopy in Pediatric Eosinophilic Esophagitis — Frontiers In Pediatrics
  19. Esophageal Food Impaction and Eosinophilic Esophagitis: A Retrospective Study, Systematic Review, and Meta-Analysis — Digestive Diseases and Sciences
  20. Esophageal Subepithelial Fibrosis in Children With Eosinophilic Esophagitis — Journal of Pediatric Gastroenterology and Nutrition

Posted on July 28, 2022


Hi I am David, I am 42 years old and was just diagnosed with EOE. It seems as though allergies play a big part in a lot of cases. I am seeing an allergist and a gastroenterologist tomorrow and I hope they will help me because I cannot swallow food at the moment. Only drinks and baby food that is watery. I am on a PPI called Protonix that has not helped with the EOE symptoms but has helped with my GERD. I started Claritin and after 2 weeks my throat started to feel better but as soon as it started working it was making my heart beat very weird so had to stop and within 3 days my throat started to go back to terrible. My PCP wants to switch me to Famotidine 40mg from the protonix because he thinks that the H2 blocker will cure my GERD and my EOE and allergies all in one pill. But who knows the future. At this point I am excited to hopefully get some relief from this.

posted June 25, 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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