Eosinophilic Esophagitis

Although not a straight forward food allergy, eosinophilic esophagitis (EoE) is becoming a prominent diagnosis co-managed by allergists and gastroenterologists.

Eosinophilic Esophagitis: What You Need to Know

Have you ever felt like food was getting stuck in your throat? For millions of people, this frustrating — and sometimes frightening — this symptom can be caused by a condition called eosinophilic esophagitis, or EoE.

What Is EoE?

EoE is a chronic inflammatory disease of the esophagus, the tube that carries food from your mouth to your stomach. It occurs when a type of white blood cell called an eosinophil builds up in the lining of the esophagus, causing swelling, stiffness, and narrowing over time. EoE affects roughly 34 out of every 100,000 people in North America and Europe, and its prevalence is rising rapidly.

What Causes It?

EoE is driven by an allergic-type immune response, most often triggered by certain foods — commonly dairy, wheat, eggs, and soy. Genetic and environmental factors also play a role. Over 90% of people with EoE have other allergic conditions, such as asthma, eczema, or seasonal allergies.

Who Does It Affect?

EoE can occur at any age, from infancy through adulthood. In young children, it may cause feeding difficulties, vomiting, or poor growth. In older children, teens, and adults, the hallmark symptoms are difficulty swallowing solid foods and food getting stuck in the esophagus (food impaction). If left untreated, ongoing inflammation can lead to scarring and permanent narrowing of the esophagus.

How Is It Diagnosed?

Diagnosis requires an upper endoscopy with biopsies of the esophagus. A pathologist looks for at least 15 eosinophils per high-power field under the microscope. Common endoscopic findings include rings in the esophagus, white patches, and linear grooves along the esophageal wall.

How Is It Treated?

Treatment centers on three approaches, sometimes called the "3 D's":

- Diet: Eliminating trigger foods — often starting with the most common allergens — can reduce inflammation and symptoms effectively.

- Drugs: Proton pump inhibitors (like omeprazole), swallowed topical corticosteroids (like budesonide or fluticasone), and the biologic medication dupilumab are all proven treatment options.

- Dilation: When strictures or narrowing develop, a gastroenterologist can gently stretch the esophagus during endoscopy.

Because EoE is a chronic condition, most patients need ongoing maintenance therapy to keep inflammation under control and prevent long-term damage.

The Bottom Line

If you experience frequent difficulty swallowing or food getting stuck, talk to your doctor. EoE is treatable, and early diagnosis can prevent complications. With the right management plan, most people with EoE can eat comfortably and live well.