In an effort to raise awareness about EoE, May 22nd, 2025, marks the first-ever World Eosinophilic Esophagitis (EoE) Day. Eosinophilic esophagitis is a chronic immune condition that causes swelling in your esophagus. It is called “EoE” for short. EoE affects people of all ages, genders, and ethnic backgrounds. About 1 in 2,000 people have EoE.

What is EoE?

At its core, EoE is a chronic, immune system disease where a specific type of white blood cell, called an eosinophil, accumulates in the lining of the esophagus – the tube that carries food from your mouth to your stomach. Normally, the esophagus has very few, if any, eosinophils. In EoE, this buildup of eosinophils causes inflammation and damage to the esophageal tissue.

Think of it like this: imagine your esophagus as a smooth, flexible pipe. In EoE, this pipe becomes irritated and inflamed, potentially narrowing and losing some of its elasticity. This inflammation can lead to a variety of uncomfortable symptoms, primarily related to difficulty swallowing.

Common Signs and Symptoms of EoE:

The way EoE presents can vary depending on age:

  • Adults: The most common symptom is dysphagia – the feeling that food is getting stuck in the throat. Other symptoms can include chest pain (not related to the heart), upper abdominal pain, and heartburn that doesn’t respond to antacids. Some adults may also learn to modify their eating habits to avoid these issues, like taking smaller bites or drinking more fluids with meals.
  • Children: Younger children may experience feeding difficulties, vomiting, abdominal pain, and failure to thrive. Older children might report symptoms similar to adults, such as food impaction and chest pain.

Who’s at Risk?

EoE can affect anyone. Males are at a higher risk. In some families, EoE may be passed down through genetics.

EoE has a strong connection to allergies. It is common for people with EoE to have other allergic diseases usually caused by type 2 inflammation. These include asthma, allergic rhinitis, or eczema. When you have type 2 inflammation, you may have more than one allergic condition. Not all people with EoE have underlying allergies. In some families, several family members may have EoE.

How Is EoE Diagnosed?

EoE cannot be diagnosed by symptoms alone. While your primary care doctor can refer you to a specialist (allergy or gastroenterology) to assess your symptoms, the formal diagnosis of EoE is done by a gastroenterologist (GI doctor) using a test called an upper GI endoscopy, or EGD. You might hear it referred to as a “scope.” During this procedure, the doctor will take photos and small tissue samples, or biopsies, of the esophagus (and possibly stomach and small intestine) to look for eosinophils.

EoE can be tricky to diagnose for many reasons. Symptoms can vary from person to person and between age groups. People with EoE may have learned to manage their symptoms by cutting their food into smaller pieces, drinking liquids when eating dry foods, putting off meals, and avoiding pills. In addition, eosinophils can be found in the esophagus for other diseases. 

If EoE goes untreated, it can lead to long-term damage to the esophagus. The tube can narrow and tighten – called a stricture – which can make it harder to swallow and pass food through to the stomach. The esophagus may need to be stretched by a GI during an endoscopy.

Unraveling the Causes:

While the exact cause of EoE isn’t fully understood, it’s believed to be a complex interplay of genetic predisposition and environmental triggers. Allergies, both food and environmental, seem to play a role in many individuals with EoE. Common food triggers can include milk, eggs, wheat, soy, peanuts, tree nuts, and seafood. However, it’s important to note that not everyone with EoE has identifiable food allergies.

Navigating the Treatment Landscape:

Currently, there’s no cure for EoE, but effective treatments are available to manage symptoms, reduce esophageal inflammation, and improve quality of life. The primary treatment strategies fall into three main categories:

  1. Dietary Therapy: There are different versions of elimination diets which may involve removing one, two, four, or as many as six food groups from your diet. However data currently shows no increased value in trying to avoid food identified via allergy testing vs just avoiding commonly implicated foods in EoE. For example, 75% of EoE cases have a dairy component and therefore a 6 week dairy avoidance trial may be recommended.
  2. Medications: Several medications are used to reduce inflammation in the esophagus:

    • Topical Corticosteroids: These are swallowed liquid or aerosolized corticosteroids (like fluticasone or budesonide) that coat the esophagus and reduce inflammation. They are often the first-line medical treatment.
    • Proton Pump Inhibitors (PPIs): While primarily used for acid reflux, PPIs can be helpful in some individuals with EoE, even if they don’t have typical reflux symptoms. The exact mechanism in EoE isn’t fully clear, but they can sometimes reduce eosinophil counts and improve symptoms.
    • Biologics: In cases of more severe or refractory EoE, newer biologic medications that target specific parts of the immune system are becoming available and showing promising results.
  3. Esophageal Dilation: If the chronic inflammation has led to significant narrowing (strictures) in the esophagus, a procedure called esophageal dilation may be necessary. This involves gently stretching the esophagus using specialized balloons or dilators during an endoscopy to improve the passage of food.

Working with Your Healthcare Team:

Managing EoE often requires a multidisciplinary approach involving gastroenterologists, allergists, dietitians, and sometimes speech therapists. They will work together to diagnose your condition accurately and develop a personalized treatment plan based on your specific symptoms and needs.

Living with EoE can present challenges, but with proper diagnosis and management, individuals can experience significant symptom relief and improved quality of life. If you suspect you or your child might have EoE, don’t hesitate to reach out to your doctor for evaluation and guidance. Additional resources, education, and support from a patient advocacy organization such as the Asthma and Allergy Foundation of America (AAFA) and Kids with Food Allergies (KFA) can also be beneficial. Understanding EoE is the first step towards effectively managing it.