Eosinophilic esophagitis (EoE) is a condition that causes an allergic reaction in your esophagus -- the tube that carries food from your throat to your stomach. When you're exposed to a trigger like food or pollen, your esophagus produces white blood cells called eosinophils as if it were reacting to an infection. These cells release chemicals that make your esophagus become inflamed and swell up.
Swelling and narrowing of the esophagus can slow or even block the movement of food and liquids through it. This causes symptoms like trouble swallowing, vomiting, and belly pain.
Having EoE adds a few challenges to your life, but you can manage them with some help from your medical team.
Its Symptoms Are Confusing
Getting an EoE diagnosis in the first place can be tricky. The condition looks a lot like gastroesophageal reflux disease (GERD) -- also called acid reflux -- and heartburn. Both conditions cause symptoms like chest pain, trouble swallowing, and vomiting, but they have different causes.
GERD happens when the muscle at the bottom of your esophagus doesn't close all the way. That open valve allows acid from your stomach to back up and irritate the lining of your esophagus.
People with reflux, like those with EoE, also have high levels of eosinophils in their esophagus. This makes it even harder to tell the two conditions apart. Your doctor might test you for reflux and other conditions that boost eosinophils before diagnosing EoE.
EoE also shares one key symptom with heart attack: chest pain. If you have chest pain, you need to see a doctor – especially if you also have other heart attack symptoms like shortness of breath or arm pain.
To be sure that you have EoE and not GERD or something else, your doctor will:
- Ask about your symptoms
- Examine your esophagus with an endoscope, which is a thin tube with a camera and light on the end
- Do a biopsy, which means remove a piece of tissue from your esophagus and test it
EoE Makes It Harder to Eat
Eosinophilic esophagitis causes symptoms like trouble swallowing, belly pain, chest pain, and vomiting that can make eating uncomfortable. Food you've eaten might come back up into your throat.
Because it's hard to swallow, some children with EoE eat very little or they won't eat at all. This can make it hard for them to get the proper nutrition that they need to grow and develop.
When EoE is severe, the esophagus can narrow so much that food gets stuck inside it. This is called a food impaction, and it's a medical emergency.
It Might Limit Your Food Choices
Food is the main cause of EoE. The most common triggers are allergen-producing foods, such as:
- Milk and other dairy products
- Peanuts and tree nuts like hazelnuts, cashews, and pecans
- Fish and shellfish like crab and shrimp
Cutting these foods out of your diet might prevent symptoms, but it's not always easy to figure out which ones bother you. Sometimes symptoms won't appear for days or weeks after you eat the offending food. Allergy blood tests and skin prick tests aren't good for finding the cause of EoE.
An elimination diet is a more accurate way to learn which foods bother you. That’s when you stop eating one or more foods for a few weeks to see if your symptoms improve.
The six-food elimination diet (SFED) is a treatment often used for EoE. On this diet, you cut out all six common food allergens -- milk, eggs, wheat, soy, nuts, and fish. About 70% of people who try the SFED get symptom relief. But, because SFED is very restrictive and sometimes hard to follow, it helps to work with a dietitian who has experience treating EoE.
You Probably Have Other Allergies, Too
Most people with EoE also have asthma, eczema, or food allergies. These allergic conditions tend to run in families, so your parents or siblings might have allergies, too.
Besides any foods that may flare up your EoE, your other allergies can trigger EoE symptoms, too. Some people have more trouble swallowing and other symptoms after they come into contact with allergic triggers like dust, mold, or pollen. A specialist called an allergist can test you for these allergies and suggest treatment if you need it.
You May Need to Take Medicine
If diet isn't enough to relieve your symptoms, medication is an option. Topical steroids and proton pump inhibitors (PPIs) reduce swelling in the esophagus. PPIs also treat reflux by blocking stomach acid.
Dupilumab (Dupixent) is the only medicine approved for EoE. It's a shot that you get once a week. Dupixent also brings down swelling in your esophagus to make it easier to swallow.
There Can Be Complications
If you let EoE go for a long time without treatment, it can damage your esophagus. Over time, scars can form in your esophagus and narrow the opening.
You may not know that you have damage and narrowing because it can happen even when your symptoms are mild. If it's hard for you to swallow, your doctor can do a medical procedure to stretch and widen your esophagus.
It Will Stick With You
EoE is a chronic condition. It won't go away, and there's no cure. But you can learn to manage its symptoms.
Finding out that you or your child has EoE can be scary. You might not know what to do. A few organizations can help you learn about the condition and how to treat it, including:
- American Partnership for Eosinophilic Disorders
- Campaign Urging Research for Eosinophilic Disease (CURED)
It takes a team of specialists to keep EoE under good control and prevent complications. You might see a(n):
Work closely with all the members of your medical team to make sure you're getting the treatment you need.
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American Academy of Allergy, Asthma & Immunology: "Eosinophilic Esophagitis."
American Family Physician: "Eosinophilic Esophagitis: A Mimic of Gastroesophageal Reflux Disease."
American Gastroenterological Association: "Six-Food Elimination Diet (SFED)."
FDA: "FDA Approves First Treatment for Eosinophilic Esophagitis, a Chronic Immune Disorder."
Gastroenterology: "Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis."
Johns Hopkins Medicine: "Eosinophilic Esophagitis."
Mayo Clinic: "Eosinophilic esophagitis." "Gastroesophageal reflux disease (GERD)."