What Is Eosinophilic Esophagitis?

Eosinophilic esophagitis (EoE) is a chronic immune system condition that affects the esophagus. The esophagus is the tube that sends food from the mouth down to the stomach. EoE happens when a type of white blood cell known as an eosinophil builds up in the esophagus and causes inflammation. The tissues of the esophagus then become damaged and swollen.^1-4

In EoE the esophageal tissue is inflamed. This can lead to problems with swallowing. Food can even get stuck in the throat. A buildup of eosinophils can be a reaction to:^1-4

• Specific food allergens
• Environmental allergens
• Acid reflux

What causes EoE?

Research is ongoing to find the underlying cause of EoE. It involves many complex immune processes that experts do not fully understand yet.^1-3

Research shows that EoE develops from a reaction to particular food allergens. There is evidence that environmental allergens can contribute as well. For example, some people with pollen allergies will develop symptoms during high pollen seasons. Genetics may also contribute to the root cause of EoE.^1-3,5

Who gets EoE?

People with environmental or food allergies, eczema, or asthma are more likely to get EoE. People assigned male at birth are also more likely to get EoE.^1-4

In addition, family history affects who gets EoE. If there are members of your family who have this disease, the chances of you getting it are higher.^1-4

What are the symptoms of EoE?

EoE can show up in various ways depending on your age. In teenagers and adults, symptoms may include:^1-4

• Undigested food coming up from your stomach into your mouth (regurgitation)
• Trouble swallowing (dysphagia)
• Pain in your chest that returns even after taking antacid medicines
• Food becoming lodged in your esophagus (impaction)

Symptoms in infants differ slightly from adults. They include:^1,2,4

• Throwing up
• Stomach pain
• Trouble feeding or food refusal
• Growth challenges such as malnutrition and weight loss

How do doctors diagnose eosinophilic esophagitis?

There are various ways that doctors diagnose EoE. These include:^1-5

• Biopsy – In this procedure, a doctor collects a small sample of tissue and looks at it under a microscope for eosinophils.
• Upper endoscopy – In this exam, a doctor inserts a long, thin tube with a light and a small camera into your mouth. They then feed it into the esophagus. This helps them get a clear look at your esophagus. They can search for any swelling, white spots, and inflammation.
• Esophageal sponge – In this test, you swallow a capsule attached to a string. When it reaches your stomach, the capsule dissolves and releases a sponge. The doctor then pulls the sponge out. On its way out, the sponge collects samples along the tissues in the esophagus. This helps your doctor determine the level of inflammation and swelling in your esophagus.
• Blood tests – These tests look at the number of eosinophils and immunoglobulin E levels in your blood. High levels can mean an allergy. But not everyone with EoE will have high levels.

How do doctors treat eosinophilic esophagitis?

There are several ways to treat EoE, including:^1-5

• Managing your diet
• Taking medicines
• Dilating the esophagus if there is narrowing or strictures

Managing your diet

There are certain foods that are known to cause reactions in people with EoE. Your doctor may recommend an elimination diet of these food groups. These foods include:1-5

• Milk (dairy)
• Eggs
• Nuts (tree nuts and peanuts)
• Wheat
• Fish, including shellfish
• Soy

In an elimination diet, you remove foods all at once and then return them one at a time, followed by repeat endoscopy and biopsies. This can help pinpoint which food is causing the inflammation. It can be helpful to work with a dietitian to ensure you are getting proper nutrition while you are on an elimination diet.^1-5

Medicines

The first drug to be approved by the US Food and Drug Administration (FDA) to treat EoE is Dupixent® (dupilumab). Dupixent is a biologic drug that reduces inflammation in the esophagus. Biologic drugs are made from living cells, as opposed to traditional drugs made from chemicals.^1,5,6

By reducing inflammation, Dupixent can allow you to swallow food more easily.^1,5,6

Other drugs used to treat EoE are:^1-5

• Corticosteroids to help reduce inflammation
• Proton pump inhibitors (PPIs) to control the amount of acid in the stomach and esophagus

Dilating the esophagus

With this procedure, your doctor stretches your esophagus if you have evidence of narrowing. It may be needed if you often have food stuck in your esophagus. Dilating the esophagus usually happens during an endoscopy.^2,5

Talk with your doctor about your treatment options and what they recommend. Together, you can decide what is best for you and your symptoms.

What is the outlook for eosinophilic esophagitis?

If you are living with EoE, it is important to make dietary changes, take medicine, and pursue other treatments. If you actively treat EoE in this way, you can live a long life with the condition. Fortunately, there is no evidence that it leads to other serious illnesses, such as cancer of the esophagus.^1,4