What is eosinophilic esophagitis?
Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that affects the esophagus, the tube that carries food from your mouth to your stomach. In people with EoE, certain white blood cells (called eosinophils) build up in the esophagus, causing swelling, discomfort, and difficulty swallowing.
While there’s no cure for eosinophilic esophagitis, treatments can help manage symptoms, reduce inflammation, and prevent long-term damage. If left untreated, EoE can lead to narrowing of the esophagus, food getting stuck, or more serious complications like scarring.
What causes eosinophilic esophagitis?
EoE is often triggered by the immune system’s response to something it sees as a threat. In about half of all cases, acid reflux plays a role. In the other half, a food allergy or sensitivity is the main cause.
What are the symptoms of eosinophilic esophagitis?
The symptoms experienced with eosinophilic esophagitis include:
- Sore throat
- Difficulties swallowing
- Burning in the esophagus
- Chest pain
- Food stuck in your throat
How is eosinophilic esophagitis diagnosed?
Eosinophilic esophagitis can only be diagnosed on biopsy obtained from the esophagus during an endoscopy. This procedure is done in the Gastroenterology department. The results from this test provide a clearer view of your esophagus to help determine a diagnosis. Following diagnosis, food and sometimes environmental allergy testing, is performed to assess for potential triggers and to help with determining a plan which is right for you.
What are the treatment options for eosinophilic esophagitis?
Because EoE is a chronic condition, treatment usually involves a long-term plan tailored to your symptoms and triggers. Common approaches include:
Dietary Therapy
Certain foods can cause the immune system to overreact, leading to inflammation. Removing trigger foods from the diet can make a big difference.
- Empiric elimination diet – This involves removing common food triggers like milk, wheat, eggs, soy, nuts, and seafood for a few months to see if symptoms improve.
- Elemental diet – This uses allergen-free formulas, typically for more severe cases or when other diets don’t work.
- Allergy testing – Food allergy testing may help identify specific triggers causing symptoms.
Medications
- Proton pump inhibitors (PPIs) – These reduce stomach acid and help calm inflammation in some people.
- Topical corticosteroids – Swallowed steroids like fluticasone or budesonide coat the esophagus and reduce swelling.
- Biologic therapy – Dupixent is an injectable medication used every two weeks. It reduces inflammation and may allow some people to reintroduce certain foods.
Esophageal Dilation
If the esophagus becomes very narrow, a doctor may need to gently stretch it with a procedure called dilation. While this helps improve swallowing, it doesn’t treat the root cause. Ongoing treatment is still needed to prevent symptoms from coming back.
Since EoE is a chronic disease, long-term care is key. Without proper treatment, inflammation can lead to scarring and serious swallowing problems. A board-certified Allergy Immunologist can help you build a customized plan to manage and treat eosinophilic esophagitis. Schedule an appointment with The Iowa Clinic's Allergy team today by calling 515.875.9260 or schedule online.