Eosinophilic Esophagitis

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Overview

Eosinophilic Esophagitis (known as EoE) is a disorder of the esophagus, the tube that connects your mouth to your stomach. EoE is increasingly recognized as a major cause of swallowing difficulties in children and adults. It affects about one in 2,000 people.

A chronic immune system disease, EoE can be triggered by a food allergy, acid reflux – when acid backs up from your stomach into your esophagus – or an airborne (seasonal) allergy. It causes your immune system to overreact, prompting a large number of white blood cells called eosinophils to collect in your esophagus. As a result, your esophagus becomes inflamed.

The condition often gets worse over time and can interfere with your quality of life. Although there is no cure, treatment is available.

Symptoms

The main symptom of EoE is difficult swallowing. Other symptoms vary by age and can include:

  • Irritability
  • Problems with feeding
  • Poor weight gain and growth among infants and toddlers
  • Reflux, when acid from the stomach backs up into the esophagus, causing a burning sensation or chest pain
  • Regurgitation, when food backs up into the mouth from the esophagus and stomach
  • Vomiting
  • Stomach pain
  • Chest pain in teens and adults

People with EoE may feel the need to drink a lot of fluids to help swallow food and may be unable to finish a meal because they feel full halfway through. In some cases, solid food can get stuck in the narrowed esophagus, potentially prompting a trip to the emergency room.

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Causes

Experts believe both genetic and environmental factors play a role in the development of EoE. About half of people with EoE also have seasonal allergies or asthma. Some notice their EoE symptoms get worse during the spring and summer when they experience seasonal allergies. Others may have food allergies or eczema (atopic dermatitis), a skin disease that causes an itchy rash.

The foods that most commonly cause an allergic reaction leading to EoE include milk, eggs, wheat, soy, peanuts or tree nuts and fish or shellfish.

You may have a combination of allergies that increase the risk of EoE. For example, although it is rare for pollen allergies alone to cause EoE, about one in four people who have food allergy-induced EoE notice a seasonal variation in their symptoms.

Diagnosis

Because symptoms of EoE are similar to gastroesophageal reflux disease (GERD) it is important to be assessed by both an allergist and a gastroenterologist to get an accurate diagnosis. Your doctor will take a complete health history and may recommend food allergy testing and an/or an upper endoscopy to check the esophagus for inflammation. For an endoscopy, the doctor will insert a tube through your mouth into your esophagus while you are sedated and may take a biopsy (a tiny bit of tissue) from the lining of your esophagus to confirm the EoE diagnosis.

Treatment

Your doctor can help you find a treatment plan that works for you. The treatment prescribed will depend on what’s triggering your EoE and the severity of your symptoms. Treatments may include:

  • Topical steroids: Topical steroids can be liquid medication you swallow, such as budesonide or inhaled and swallowed, such as fluticasone. Though not approved for EoE by the U.S. Food and Drug Administration (FDA), they are commonly prescribed. These medications may help calm the inflammation in the esophagus.
  • Proton pump inhibitors (PPI): PPIs are oral medications that reduce the acid in your stomach. Although they are not approved for EoE by the FDA, they are commonly prescribed.
  • Diet therapy: The allergist may recommend you eliminate all foods that are common triggers of EoE, including tree nuts, peanuts, fish and shellfish, wheat, dairy products, eggs and soy products. If tests show you have specific food allergies, your allergist may recommend you stop eating those foods to see if your symptoms improve. Another possible treatment is the elemental diet, a special liquid or powder nutrition replacement taken for up to six weeks to allow your esophagus time to heal.
  • Esophageal dilatation: If your esophagus gets too narrow, your doctor may recommend stretching it. This can be done during the endoscopy. A balloon is inserted through the tube placed in your throat and blown up to stretch the area that has become narrow.
  • Biologic therapy: Biologics are newer, targeted therapies that reduce inflammation. Biologics are provided by injection or IV (intravenous). The FDA has given orphan drug designation or breakthrough therapy designation to several biologics, including dupilumab (Dupixent®), and benralizumab (Fasenra®). The FDA may approve these biologics and others for EoE in the near future.

Use the Find an Allergist tool to find expert care for EoE.

Content updated 9/21/21.