Eosinophilic Esophagitis (EoE)

What is Eosinophilic Esophagitis (EoE)?

Eosinophilic esophagitis is a chronic immune system disease that affects your esophagus. The esophagus is the tube that connects your mouth to your stomach. In people with EoE, a type of white blood cell called eosinophils builds up in the lining of the esophagus.

Eosinophils normally help your body fight infections. But when too many gather in the esophagus, they cause inflammation and tissue damage. This buildup happens as a reaction to certain foods, allergens in the air, or acid reflux.

EoE is becoming more common, especially in people who have other allergic conditions. It can affect anyone at any age. Without treatment, chronic inflammation can lead to scarring and narrowing of the esophagus over time.

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Symptoms

Difficulty swallowing solid foods
Food getting stuck in the esophagus
Chest pain that does not respond to antacids
Heartburn or reflux symptoms that do not improve with medication
Nausea or vomiting
Abdominal pain
Poor appetite or difficulty eating
Weight loss or poor growth in children
Regurgitation of undigested food

Some people adapt to symptoms over time by eating slowly, chewing thoroughly, or avoiding certain foods. This can make the condition harder to recognize early on.

Causes and risk factors

EoE is caused by an abnormal immune response to certain triggers. Food allergens are the most common cause. Common food triggers include milk, eggs, wheat, soy, peanuts, tree nuts, fish, and shellfish. Citrus fruits like lemons can also trigger symptoms in some people. Environmental allergens like pollen, dust mites, and mold may play a role too.

Risk factors include having other allergic conditions like asthma, eczema, or seasonal allergies. Family history matters, as EoE tends to run in families. Being male increases your risk, as men are diagnosed more often than women. Living in cold or dry climates may also increase risk, though researchers are still studying why.

How it's diagnosed

Diagnosing EoE requires an upper endoscopy with biopsies. During this procedure, a doctor inserts a thin tube with a camera down your esophagus. They take small tissue samples from the esophagus lining to check for eosinophils under a microscope. A count of 15 or more eosinophils per high-power field confirms the diagnosis.

Blood tests can help identify potential food triggers. Testing for food-specific IgG antibodies, like Lemon IgG, may point to foods causing immune reactions. However, these blood tests alone cannot diagnose EoE. Talk to a doctor about which tests are right for you based on your symptoms and health history.

Treatment options

Elimination diets to remove trigger foods, often starting with common allergens like dairy, eggs, wheat, and soy
Elemental diets using amino acid-based formulas in severe cases
Swallowed topical corticosteroids like fluticasone or budesonide to reduce inflammation
Proton pump inhibitors to reduce stomach acid and inflammation
Esophageal dilation to stretch narrowed areas if scarring has occurred
Working with an allergist to identify specific food triggers through testing or food reintroduction
Avoiding known environmental allergens when possible
Regular follow-up endoscopies to monitor inflammation and treatment response

Frequently asked questions

EoE is caused by an abnormal immune response to food allergens or environmental triggers. Common food triggers include milk, eggs, wheat, soy, nuts, and seafood. Your immune system mistakenly treats these foods as threats, sending eosinophils to the esophagus where they cause inflammation.

EoE is a chronic condition that typically does not go away without treatment. Symptoms may come and go, but the underlying inflammation persists. Without treatment, ongoing inflammation can cause permanent scarring and narrowing of the esophagus. Early diagnosis and treatment are important to prevent long-term damage.

EoE involves immune system inflammation caused by allergens, while acid reflux is caused by stomach acid backing up into the esophagus. EoE symptoms often do not improve with standard reflux medications. The two conditions can look similar, but EoE requires an endoscopy with biopsies to confirm elevated eosinophils in the esophagus tissue.

The most common trigger foods are milk, eggs, wheat, soy, peanuts, tree nuts, fish, and shellfish. However, triggers vary from person to person. Many doctors recommend an elimination diet to identify your specific triggers. You remove common allergens for several weeks, then slowly reintroduce them one at a time while monitoring symptoms.

EoE itself is not life-threatening, but it can seriously affect your quality of life. Untreated EoE can lead to scarring and narrowing of the esophagus, making swallowing difficult. Food may get stuck in the esophagus, requiring emergency care. Early treatment helps prevent these complications and maintains normal esophageal function.

Blood tests alone cannot diagnose EoE. Diagnosis requires an endoscopy with biopsies to count eosinophils in esophageal tissue. However, blood tests for food-specific IgG antibodies can help identify potential trigger foods. These tests measure immune reactions to foods like lemon, dairy, or wheat that may be contributing to your symptoms.

Children with EoE may refuse to eat, have feeding difficulties, or fail to gain weight properly. They may vomit frequently or complain of stomach pain. Older children might avoid certain textures of food or eat very slowly. Many children adapt to symptoms without realizing something is wrong, so parents should watch for persistent feeding issues.

Most doctors recommend follow-up endoscopies every few months when first diagnosed or changing treatments. This helps monitor whether inflammation is improving. Once your EoE is well-controlled, you may only need endoscopies every one to three years. Your doctor will create a monitoring schedule based on your symptoms and treatment response.

Stress does not directly cause EoE, but it can worsen symptoms. Stress affects your immune system and may increase inflammation throughout your body. It can also trigger behaviors like eating quickly or not chewing thoroughly, which make swallowing problems worse. Managing stress through relaxation techniques may help reduce symptom flares.

There is currently no cure for EoE, but it can be effectively managed with treatment. Many people achieve remission, meaning their symptoms disappear and inflammation resolves. Treatment usually involves dietary changes, medications, or both. Lifelong management is typically needed, as stopping treatment often causes symptoms to return.