GoodRx Guide
Eosinophilic Esophagitis (EoE): Your GoodRx Guide
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Definition
Eosinophilic esophagitis (EoE) is a chronic allergic medical condition that affects the esophagus. The esophagus is the tube that connects the mouth to the stomach.
People with eosinophilic esophagitis have high numbers of eosinophils (a type of infection-fighting cell) present in the lining of the esophagus. Eosinophils cause swelling and tissue damage inside the esophagus, which can lead to symptoms like heartburn, nausea, or difficulty swallowing.
The EoE symptoms can be very similar to gastroesophageal reflux disease (GERD). But GERD is more common than eosinophilic esophagitis, and it’s treated differently.
Causes
A combination of genetic and environmental factors can lead to eosinophilic esophagitis. In people at higher risk for developing EoE, eating particular foods leads to a hyperactive immune response. In other words — the infection-fighting system of the body turns on. The foods that are most likely to trigger this immune system response include milk, wheat and gluten, and eggs.
Eosinophilic esophagitis isn’t very common — only about 150,000 people in the United States have it. But the number of people with EoE is increasing, and it isn’t clear why. EoE can affect infants, children, and adults of any age.
People with eosinophilic esophagitis often have other allergic conditions like:
Allergic rhinitis
Eczema
Asthma
Symptoms
The symptoms of eosinophilic esophagitis depend on age. In infants and young children, EoE symptoms include:
Difficulty feeding
Discomfort or pain while feeding
Vomiting
Abdominal pain
Not gaining weight
Not growing
Adults with EoE often experience:
Difficulty swallowing
Food impaction (getting food stuck in the esophagus)
Heartburn
The symptoms of eosinophilic esophagitis are caused by inflammation in the esophagus. Inflammation causes swelling, which narrows the opening of the esophagus. This makes it more difficult for food to pass through, leading to symptoms like getting food stuck in the esophagus and pain with swallowing. Over time, scar tissue may form (called fibrosis) and make symptoms worse.
Diagnosis
It can be difficult for healthcare professionals to diagnose someone with eosinophilic esophagitis. Symptoms like heartburn or vomiting can be caused by many different gastrointestinal issues. And healthcare professionals will make sure to rule out these common problems first.
After that, people often need a test called an upper endoscopy (esophagogastroduodenoscopy or EGD). During an upper endoscopy, a gastroenterologist will use a camera to directly look at the esophagus and take samples (biopsy) of the area. These samples will be examined under a microscope to look for eosinophils, which confirms the diagnosis of EoE.
Medications
Eosinophilic esophagitis can be treated with medication. In addition to relieving symptoms, medications can help prevent long-term damage to the esophagus. Common options include:
Proton pump inhibitors: Proton pump inhibitors (PPIs) decrease acid production in the stomach and stop acid from moving into the esophagus. PPIs are used commonly to treat GERD. But many people with EoE benefit from using a PPI.
Steroids: Corticosteroids like fluticasone and budesonide are commonly used to treat EoE. These medications reduce inflammation in the esophagus.
Immune system modulators: Researchers are studying new medications that directly target the immune system for the treatment of EoE. Dupilimab (dupixent) was recently approved by the FDA to treat EoE.
Since eosinophilic esophagitis is triggered by allergens in food, adjusting the diet can help treat it. Some diets that are effective include:
Elemental diet: Infants and young children with EoE can be fed an amino acid-based formula.
Six-food elimination diet: In this diet, people avoid the six foods most likely to trigger EoE. After several weeks, the foods are slowly brought back into the diet one at a time, to try to see which ones people can eat without triggering symptoms.
In severe cases of eosinophilic esophagitis, scar tissue forms narrow rings around the esophagus, called strictures. If the strictures are very tight, food can have a difficult time getting through to the stomach. A procedure called an esophageal dilatation can help to stretch open the esophagus.
Frequently asked questions about EoE
Yes, people with eosinophilic esophagitis have a normal life. Symptoms are treatable with medication and diet changes. However, EoE is a chronic condition, which means that treatment is usually lifelong.
Autoimmune diseases occur when our infection-fighting system incorrectly targets and attacks the body. In EoE, the immune system is targeting an outside trigger (an allergen in food), but has a hyperactive response that causes damage to the esophagus. There are similarities between EoE and autoimmune diseases. But EoE is usually described as an allergic disease or an immune-based inflammatory disease rather than an autoimmune disease.
It’s possible for some people to manage eosinophilic esophagitis through diet change alone. But there’s no cure for EoE. So while diet changes can help lower inflammation, they will not completely heal the condition. And you’d have to follow your elimination diet to keep symptoms from coming back.
References
American Society for Gastrointestinal Endoscopy. (n.d) Understanding esophageal dilation.
Alexander, E. S., et al. (2014). Twin and family studies reveal strong environmental and weaker genetic cues explaining heritability of eosinophilic esophagitis. The Journal of Allergy and Clinical Immunology.
Arias, A., et al. (2021). Epidemiology and risk factors for eosinophilic esophagitis: Lessons for clinicians. Expert Review of Gastroenterology & Hepatology.
Arnold, M. J. (2021). Eosinophilic esophagitis: Management guidelines from the AGA and JTF. American Family Physician.
Capucilli, P., et al. (2019). Allergic comorbidity in eosinophilic esophagitis: Mechanistic relevance and clinical implications. Clinical Reviews in Allergy & Immunology.
Chin, M., et al. (2021). Eosinophilic esophagitis. American College of Gastroenterology.
Clayton, S., & Emerson, J. F. (2018). Eosinophilic esophagitis: A mimic of gastroesophageal reflux disease. American Family Physician.
Dellon, E. S., et al. (2018). Updated international consensus diagnostic criteria for eosinophilic esophagitis: Proceedings of the AGREE conference. Gastroenterology.
Feo-Ortega, S., et al. (2022). Evidence-based treatments for eosinophilic esophagitis: Insights for the clinician. Therapeutic Advances in Gastroenterology.
Gonsalves, N. P., et al. (2020). Diagnosis and treatment of eosinophilic esophagitis. The Journal of Allergy and Clinical Immunology.
Greuter, T., et al. (2020). Emerging therapies for eosinophilic esophagitis. The Journal of Allergy and Clinical Immunology.
Haller, E., et al. (2021). Six-food elimination diet (SFED). American Gastroenterological Association.
Molina-Infante, J., et al. (2018). Dietary therapy for eosinophilic esophagitis. Journal of Allergy and Clinical Immunology.
Muir, A., et al. (2021). Eosinophilic esophagitis: A review. JAMA.
U.S. Food and Drug Administration. (2022). FDA approves Dupixent for eosinophilic esophagitis; expands indication for atopic dermatitis.
