Eosinophilic Esophagitis (EoE)

What is eosinophilic esophagitis?

Eosinophilic esophagitis (EoE) is a long-term (chronic) allergic and immune condition that happens in the esophagus. The esophagus is the tube that connects the back of your throat to your stomach. Food and liquid go down the tube when you swallow. Eosinophils are white blood cells found in the digestive tract. But they are not normally found in the esophagus. With EoE, your immune system reacts to allergens in the esophagus. It makes and multiplies eosinophils in the esophagus. This causes the esophagus to become inflamed. It can get narrowed and develop rings or pus-filled infections (abscesses). This can cause symptoms such as trouble swallowing.

What causes eosinophilic esophagitis?

EoE is caused by an allergic reaction to certain foods or other allergens in the environment.

Who is at risk for eosinophilic esophagitis?

EoE affects people of all ages and ethnic backgrounds. But it's more commonly seen in men. You are more at risk if you have:

• Atopic dermatitis

• Asthma

• Food allergies

• Environmental allergies

• Family history of EoE

Some other health conditions can cause eosinophils to increase in the esophagus. Your healthcare provider will need to test you for these conditions.

What are the symptoms of eosinophilic esophagitis?

Symptoms can occur a bit differently in each person. They can include:

• Trouble swallowing

• Chest pain or heartburn

• Belly (abdominal) pain

• Vomiting

• Food getting stuck in the throat due to narrowing (a medical emergency)

• Not enough growth or weight gain in children

The symptoms of EoE can seem like other health conditions. See your healthcare provider for a diagnosis.

How is eosinophilic esophagitis diagnosed?

You may see a healthcare provider called a gastroenterologist. They will ask about your symptoms and health history and give you a physical exam. They may also ask about your family’s health history. You may also have tests, such as:

• Allergy testing. This is a series of tests to see what substances you are allergic to.

• Endoscopy. Your healthcare provider uses a tiny camera on a thin, flexible tube to look inside your esophagus for signs of irritation. They will likely need to take a small sample of tissue (biopsy) from your esophagus.

How is eosinophilic esophagitis treated?

You will work with an allergist or a gastroenterologist. No medicines can cure EoE. But some medicines can reduce the swelling in your esophagus. These include:

• Corticosteroids

• Proton pump inhibitors

Your healthcare provider will often try high-dose acid blockers for up to 8 weeks after diagnosis. They will then reassess you and your symptoms.

You can help manage EoE by learning what causes your allergic reaction and staying away from those things. In many cases, the allergens come from food. Your healthcare provider will help you find out what substances or foods to stay away from. Unfortunately, allergy tests are not always helpful in this condition.

When starting a food elimination plan, it may take days or weeks to see which foods you are allergic to. This is because reactions related to EoE might take days or weeks to develop. You may need to not eat foods, such as:

• Dairy

• Eggs

• Wheat

• Soy

• Peanuts

• Tree nuts, such as almonds

• Fish and shellfish

In some cases, the esophagus needs to be stretched (dilated) if it has narrowed.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of eosinophilic esophagitis?

If left untreated, symptoms will continue. This can damage the esophagus and cause it to narrow. The long-term complications of EoE are not fully understood.

What can I do to prevent eosinophilic esophagitis?

Researchers don’t know how to prevent the condition. But managing your contact with allergens can help lessen symptoms.

Living with eosinophilic esophagitis 

EoE is a chronic condition. You will need to manage it for the rest of your life. This includes staying away from the foods or allergens that cause your allergic reaction. In many cases, you will need to stay on medicines. You may need occasional follow-up testing, such as endoscopy.

It’s important to work closely with your gastroenterologist. They can tell you when you need tests to see if the EoE is getting better or worse. An allergist and dietitian can help you manage related problems, such as asthma, allergic rhinitis, and food allergies.

Also think about joining a support group or checking out a group, such as the American Partnership for Eosinophilic Disorders (APFED), for tips on coping with EoE.

When should I call my healthcare provider?

Call your healthcare provider if you have EoE and notice any of these symptoms:

• Unexplained weight loss

• Increasing or persistent vomiting

• Stomach pain

• Difficulty swallowing does not improve after treatment

Key points about eosinophilic esophagitis

• Eosinophilic esophagitis (EoE) is an allergic condition that inflames the esophagus. It can get narrowed and develop rings or abscesses. This can cause symptoms, such as trouble swallowing.

• EoE is caused by allergies to certain foods or other allergens in the environment. A person is more at risk if they have asthma or allergies.

• Symptoms can include trouble swallowing, belly pain, and vomiting.

• You may need allergy testing to see what substances you are allergic to. You may need to take medicines and change your diet.

• EoE is a chronic condition. You will need to manage it for the rest of your life. This includes staying away from the foods or allergens that cause your allergic reaction.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.