Eosinophilic Esophagitis (EoE): Causes, Symptoms, and Treatment Explained

What Is Eosinophilic Esophagitis?

Eosinophilic esophagitis, often called EoE, is a long-term condition that affects the esophagus—the tube that carries food from your mouth to your stomach.

In EoE, certain white blood cells called eosinophils build up in the lining of the esophagus. These cells are part of your immune system. They normally help fight infections and respond to allergies. But in EoE, they collect in the esophagus when they should not be there.

Over time, this buildup causes swelling and irritation. The esophagus can become stiff or narrow, making it harder to swallow food.

EoE is not cancer. It is not contagious. It is a treatable condition.

What Causes EoE?

EoE is usually triggered by an allergic reaction.

For many people, certain foods cause the immune system to react. Common triggers include:

• Milk

• Wheat

• Eggs

• Soy

• Nuts

• Seafood

  
  

Some people may also react to environmental allergens like pollen.

EoE is more common in people who have:

• Asthma

• Eczema

• Seasonal allergies

• Food allergies

  
  

It can affect both children and adults, but it is often diagnosed in young or middle-aged adults.

What Are the Symptoms?

Symptoms of EoE can develop slowly over time.

In Adults, Common Symptoms Include:

• Trouble swallowing (especially solid foods)

• Food getting stuck in the throat (food impaction)

• Chest discomfort

• Heartburn that does not improve with standard reflux medication

• Needing to drink a lot of water to swallow food

  
  

Many adults adjust their eating habits without realizing it. You might:

• Chew very carefully

• Cut food into tiny pieces

• Avoid meats or bread

• Eat slowly

• Avoid eating in public

  
  

If food becomes completely stuck and won’t pass, this is a medical emergency and requires urgent care.

How Is EoE Diagnosed?

EoE cannot be diagnosed by symptoms alone.

Your doctor will likely perform an upper endoscopy. During this test:

• A thin, flexible camera is passed through the mouth into the esophagus.

• The lining of the esophagus is examined.

• Small tissue samples (biopsies) are taken.

  
  

Even if the esophagus looks normal, biopsies are important. The diagnosis is made by finding a high number of eosinophils under a microscope.

Your doctor may also rule out acid reflux disease (GERD), which can cause similar symptoms.

What Does the Esophagus Look Like in EoE?

Doctors may see:

• Rings (sometimes called “trachealization”)

• Long lines or furrows

• White patches

• Narrowing of the esophagus

In some cases, the esophagus looks normal, which is why biopsies are essential.

How Is EoE Treated?

The good news is that EoE is treatable. The goal is to reduce inflammation and prevent long-term damage.

Treatment usually falls into three main categories: medications, diet changes, and dilation.

1. Medications

Proton pump inhibitors (PPIs) These medications reduce stomach acid. Some patients improve with acid suppression alone.

Topical steroids These are swallowed (not inhaled) steroids that coat the esophagus and reduce inflammation. Common options include:

• Fluticasone (swallowed from an inhaler without breathing it in)

• Budesonide (liquid or slurry form)

Dupilimumab (Dupixent) This is a once weekly self-administered injection under the skin.

These medications work well and are generally safe when used as directed.

2. Dietary Therapy

Because EoE is often food-driven, removing trigger foods can be very effective.

Common approaches include:

Six-food elimination diet Removes milk, wheat, eggs, soy, nuts, and seafood.

Step-up elimination Start by removing one or two common triggers (often milk and wheat), then adjust based on response.

Targeted elimination Remove specific foods based on allergy testing (though testing is not always accurate for EoE).

Diet therapy requires follow-up endoscopies to confirm healing.

3. Esophageal Dilation

If the esophagus becomes narrow, your doctor may gently stretch it during an endoscopy.

Dilation helps improve swallowing but does not treat the underlying inflammation. Most patients still need medication or diet therapy.

Is EoE a Lifelong Condition?

Yes, EoE is considered chronic. That means it usually requires ongoing treatment.

If left untreated, inflammation can lead to:

• Scarring

• Narrowing (strictures)

• Repeated food impactions

With proper treatment, most people:

• Swallow normally

• Avoid emergency visits

• Maintain a normal quality of life

Regular follow-up with your gastroenterologist is important.

When Should You See a Doctor?

You should talk to a doctor if you:

• Frequently feel food sticking

• Have ongoing swallowing trouble

• Have food impactions

• Have reflux symptoms that don’t improve with treatment

  
  

Early diagnosis helps prevent long-term complications.

📌 Key Takeaways

• EoE is a chronic allergic condition of the esophagus.

• It causes trouble swallowing and food getting stuck.

• Diagnosis requires endoscopy with biopsies.

• Treatment includes medications, diet changes, and sometimes dilation.

• With proper care, most patients do very well.

Final Thoughts

Eosinophilic esophagitis can be frustrating and even frightening when food gets stuck. But with today’s treatments, most patients achieve excellent control.

If you think you may have EoE, speak with a gastroenterologist. Early treatment can protect your esophagus and improve your quality of life.

Medical Disclaimer

This article is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Always consult your physician with questions about your medical condition.