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Eosinophilic Esophagitis

Symptoms | Diagnosis and Treatment | For More Information

Eosinophilic esophagitis (EoE) is a condition that affects the esophagus, the tube that carries food from the mouth to the stomach. In EoE, the esophagus contains eosinophils, these type of cells can be involved in fighting certain infections, autoimmunity or allergy, not normally found in the body’s food pipe. Eosinophils collect in the gut lining, affecting gut function. Before diagnosing EoE other causes of eosinophilia in the esophagus need to be excluded. Reflux (acid) or PPI responsive EoE in the esophagus can cause some eosinophils to be present. Other diseases can be excluded with a biopsy.

Food allergy has been implicated as major cause of EoE, but other allergies, unknown triggers and heredity play a role. Many individuals with EoE have other allergic disorders such as eczema, allergic rhinitis (nasal and environmental allergies), asthma and/or an IgE-mediated food allergy that may cause hives, wheezing and rapid onset of stomach pain.

EoE sometimes runs in families and can develop in both children and adults.

Eosinophilic Esophagitis (EoE) Symptoms

Eosinophilic esophagitis most commonly causes difficulty swallowing  as the esophagus does not contract as well. Food may get stuck or go down slowly. Additional EoE symptoms may include:

  • chest pain
  • abdominal pain
  • heartburn
  • poor appetite
  • need to eat slowly
  • vomiting
  • poor growth
  • food impaction or lodging in the esophagus

EoE symptoms can be different, depending on a person’s age.

Adults and teens often have:

  • trouble swallowing, usually with solid foods. Some have pain with swallowing or feel as if food is lodged in their throat or chest.
  • chest or upper belly pain
  • burning in the chest (heartburn) that doesn’t get better after taking medicine to treat heartburn

Children often have:

  • feeding problems, such as refusing to eat solid foods, that lead to poor growth
  • nausea or vomiting
  • belly pain

Eosinophilic Esophagitis Diagnosis and Treatment

Eosinophilic Esophagitis treatment usually involves diet changes (elimination diet), medications (topical steroids) and/or procedures to dilate or widen the esophagus, if needed.

Diet modification is often recommended in treating EoE. Your doctor might have you avoid foods that could be causing your symptoms. Any recommended elimination diet is recommended for a minimum of 8 weeks, with repeat endoscopy with biopsies to follow the course of treatment. Unfortunately, at this time, this is the only way to know if the EoE is responding to treatment (or if foods can be added back to the diet). Three main diets include:

  • Avoiding the foods that most commonly cause EoE. A six-food elimination diet may be tried. With this diet, patients are advised to avoid milk, wheat, soy, egg, nuts and seafood. To make sure that you are receiving enough calories and nutrition, it is helpful to meet with a nutritionist prior to starting this diet.
  • Eliminating the foods you are allergic to. Working in collaboration with NorthShore’s allergists. Unfortunately, currently available testing is often not very accurate at pinpointing the foods involved and allergy testing is often not performed. 
  • Going on a special liquid diet, using elemental (allergen-free) formula and avoiding all solid foods.

Unless you have had a history of an IgE-mediated allergic reaction, (such as rash, hives, wheezing, coughing or suddenly occurring abdominal pain) to the typical trigger foods, an epinephrine auto injector (e.g., EpiPen®) is not needed for patients with EoE. Many patients, though, can have both types of allergic reactions and should consult with their doctors about the best course of Eosinophilic Esophagitis treatment. EoE can also have environmental triggers so it is important to work with your allergist to understand and control all of your allergies

Medication such as topical steroids may be used to help reduce inflammation. These medications can help treat the EoE symptoms but not the cause.

In some people, EoE leads to a condition called an esophageal stricture—narrowing of the esophagus caused by scar tissue. The main treatment for an esophageal stricture is Esophageal Dilation, an endoscopic procedure to widen the esophagus. The degree of stricture and the extent of the blockage may limit food intake and lead to weight loss. In severe pediatric cases, if other treatments fail and the child is not growing, it may be necessary to insert a feeding tube and feed the child with elemental (allergen-free) formula.

The long-term course of the illness is not well understood and there is no cure at the present time. We do not know if this will be outgrown in children and teens. The main concern with EoE is the risk of food lodging in the esophagus, which in rare occasion can lead to a perforated esophagus and can be life threatening.

For More Information

For more information or to make an appointment with a gastroenterologist, please call 847.657.1900.