Science-Backed Treatments for Eosinophilic Esophagitis

Inflammation is an important process that helps fight infections and heal wounds. But uncontrolled inflammation can lead to damage in the body.

That’s the case with eosinophilic esophagitis, an allergic condition that causes inflammation in the esophagus. In eosinophilic esophagitis, triggers cause inflammation in the esophagus. This inflammation causes pain, difficulty swallowing, and other symptoms. Eosinophilic esophagitis can be a lifelong condition. But treatment can ease symptoms, and prevent inflammation and damage to the esophagus.

What causes eosinophilic esophagitis?

It’s not clear exactly what causes eosinophilic esophagitis. 

Experts think that eosinophilic esophagitis is an allergic reaction in response to a trigger that causes the immune system to activate when it shouldn’t. Often, the trigger is food, like milk, eggs, or wheat. But there’s evidence, though not firm enough, that eosinophilic esophagitis may also be triggered by environmental allergens like pollen or dust. 

When people with eosinophilic esophagitis encounter this trigger, their immune system sends eosinophils into the esophagus. These white blood cells cause inflammation. Over time, inflammation can damage the esophagus and lead to scarring.

Who’s most at risk of eosinophilic esophagitis?

Eosinophilic esophagitis can affect children and adults of any age. But it tends to occur more often in children between 5 and 12 years old and adults around age 30. People are also more likely to develop eosinophilic esophagitis if they have:

• A family member with eosinophilic esophagitis

• Food or environmental allergies

• Asthma

• Atopic dermatitis (eczema)

What are the symptoms of eosinophilic esophagitis?

The symptoms of eosinophilic esophagitis vary depending on age. 

Kids with eosinophilic esophagitis may have symptoms like:

• Difficulty feeding 

• Poor weight gain

• Vomiting

• Abdominal pain

Adults with eosinophilic esophagitis often have:

• Heartburn

• Chest pain

• Trouble swallowing solid foods

• Food getting stuck in the esophagus

These symptoms can be caused by other medical conditions, too. Many of these conditions are much more common than eosinophilic esophagitis. That’s why it can be challenging for healthcare professionals to diagnose eosinophilic esophagitis. 

How is eosinophilic esophagitis diagnosed?

Eosinophilic esophagitis is diagnosed with an upper endoscopy, also called esophagogastroduodenoscopy (EGD). 

During an upper endoscopy, a small camera is inserted into the throat to look for signs of inflammation in the esophagus and collect small tissue samples. These samples are examined under a microscope. Eosinophilic esophagitis can be diagnosed if these samples contain many eosinophils. 

What is the treatment for eosinophilic esophagitis?

Treatment for eosinophilic esophagitis includes diet changes and medication. Without treatment, eosinophilic esophagitis can cause scar tissue to form in the esophagus. This makes it difficult for food to pass through to the stomach. Let’s take a closer look at each of these treatments for eosinophilic esophagitis. 

Diet changes

Eosinophilic esophagitis is often triggered by a food allergy. So diet changes are the first step in treating eosinophilic esophagitis. There are several diets used to treat eosinophilic esophagitis. 

• Elemental diet: An elemental diet is sometimes used to treat eosinophilic esophagitis in infants and young children. Instead of eating regular food or formula, kids are given a special amino-acid-derived formula that doesn’t contain any food allergens. This diet is very restrictive, and not ideal for long-term treatment. But it may be recommended in severe cases or when other treatment options haven’t been successful. 

• Food elimination diet: In a food elimination diet, a person stops eating one or more foods likely to trigger eosinophilic esophagitis. One elimination diet is the six-food elimination diet (SFED). People following this diet stop eating six major foods linked to food allergies. This includes cow’s milk, wheat, peanuts/tree nuts, egg, soy, and seafood/shellfish. After 6 to 8 weeks, a repeat upper endoscopy is performed. If the esophagus is healing, then the person may then be able to start eating these foods again.

• Food elimination diet based on allergy testing: Instead of eliminating all possible food allergies, some people opt for food allergy testing first. Then they adjust their diet according to the test results. But food allergy testing isn’t always able to identify the food causing eosinophilic esophagitis. So this process may not work for everyone.

Medications

In addition to diet changes, your healthcare professional may recommend medication to help treat eosinophilic esophagitis. These include: 

• Proton pump inhibitors: Proton pump inhibitors (PPIs) reduce acid in the stomach. They’re a common treatment for gastroesophageal reflux disease (GERD). PPIs can help treat symptoms of eosinophilic esophagitis. Most people with eosinophilic esophagitis need more treatment in addition to PPIs.

• Corticosteroids: Corticosteroids are a key part of treatment for eosinophilic esophagitis. In studies, two-thirds of people got better with steroid treatment. The most common steroids used to treat eosinophilic esophagitis are budesonide and fluticasone. These medications are often given in the form of an inhaler, just like the ones used to treat asthma. But people are asked to swallow the medication rather than inhale it. This way, the steroids coat the esophagus. Budesonide also comes in liquid form, which can be easier for young children to use. 

• Dupilumab: Dupilumab (Dupixent) is a monoclonal antibody that acts on the immune system to reduce inflammation. In the past, it has been used to treat atopic dermatitis and asthma. However, in 2022 it was approved by the FDA to treat eosinophilic esophagitis. One study showed that weekly treatment with dupilumab improved symptoms and inflammation of the esophagus in people with eosinophilic esophagitis. 

Endoscopic procedures

Upper endoscopy is necessary to diagnose eosinophilic esophagitis. And repeat endoscopies are usually needed in order to monitor response to treatment. In some cases, upper endoscopy can also be used to treat some of the complications of eosinophilic esophagitis. 

If eosinophilic esophagitis goes untreated, scarring in the esophagus can lead to the formation of esophageal strictures. An esophageal stricture is a narrowing of the esophagus, which makes it harder for food to pass through. During an upper endoscopy, a gastroenterologist may perform an esophageal dilation to stretch open (dilate) the esophagus.

Why trust our experts?

Written by:

Meredith Grace Merkley, DO, FAAP

Dr. Merkley is a licensed, board-certified pediatrician who has over a decade of experience working in community health. She is currently a National Health Services Corp scholar, and is serving as the medical director of a school-based health clinic at a federally funded health center.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

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