What Is Eosinophilic Esophagitis?

Medically Reviewed by Brunilda Nazario, MD on February 24, 2022
5 min read

Not so long ago, if you had eosinophilic esophagitis, or EoE, your doctor probably thought you had gastro-esophageal reflux disease (GERD), also known as acid reflux. The only problem was that GERD medication didn’t make you any better. It wasn’t until the 1990s that doctors realized that EoE isn’t caused by GERD. It’s a similar but totally separate condition.

Eosinophilic esophagitis is a chronic immune system disease that has identical symptoms to the digestive disease GERD (gastroesophageal reflux disease), like trouble swallowing and chest pain.

Eosinophilic esophagitis was considered a children’s disease for many years, but now adults are being diagnosed more and more. Experts think that this is partly because doctors are more aware of it, but also because there have been more cases of related conditions like allergies and asthma.

EoE symptoms include:

All of these symptoms are also signs of GERD, which is why the two conditions were thought to be the same for so long. The key to diagnosing eosinophilic esophagitis is that people with the condition don’t get better with GERD medications.

It happens when white blood cells called eosinophils build up in your esophagus, the tube that connects your mouth to your stomach.

These eosinophils are supposed to stay in your digestive tract. An allergic reaction usually makes them move into the esophagus, which causes inflammation and discomfort.

Food allergies. This seems to be the biggest risk factor for EoE, but doctors aren’t certain how it works. They haven’t figured out how and why certain foods trigger white blood cells to travel to the esophagus, or why this reaction happens in some people and not others. Dairy, eggs, soy, and wheat are usually the culprits.

Other allergies. Up to 70% of people with EoE also have environmental allergies, asthma, eczema, atopic dermatitis, or allergic rhinitis.

Sex and age. EoE used to be known as a children’s condition, but more adults are being diagnosed now. About three times more men have eosinophilic esophagitis than women, and they’re usually diagnosed between the ages of 20 and 40.

Family history. Genetics definitely play a part in EoE, but scientists aren’t sure how big a factor they are. What they do know is that you’re more likely to get eosinophilic esophagitis if one of your relatives has had it.

Climate. If you live in a cold or dry area, you’re more likely to get EoE. It also tends to flare up in the spring, summer, and fall.

EoE is the most common cause of white blood cells in the esophagus, but other things (like GERD, parasites, and inflammatory bowel disease) can also be causes. And because the symptoms of eosinophilic esophagitis and GERD are virtually identical, your doctor will have to rule out acid reflux before settling on a diagnosis.

They can do this with tests called an upper endoscopy and a biopsy. White blood cells will usually show themselves on the endoscopy as pale or white flecks. There could also be lines, creases, and other signs of inflammation.

But things could also look normal even if you have white blood cells present, which is why your esophageal tissue will also need to be biopsied.

If you have eosinophils in your esophagus, your doctor will start you on GERD medication to see if it helps your symptoms. If your next endoscopy and biopsy are normal, acid reflux is the problem. If not, it’s probably EoE.

The tried-and-true treatment for children with EoE is dietary therapy. Allergy tests can sometimes pinpoint which food is the problem, but more often an elimination diet does the trick. You take major food allergens out of your child’s diet and then add them back one at a time. Figuring out food allergies has been shown to clear up the white blood cells within weeks.

There’s no single accepted therapy for adults, possibly because EoE has been primarily a children’s issue for so long. Adults can do dietary elimination as well, but sometimes doctors will also prescribe oral steroids. Esophageal dilation, which is stretching the esophagus, is a short-term fix that helps symptoms but doesn’t get rid of the white blood cells.

Common foods that tend to trigger a worsening of EoE symptoms include milk, eggs, soy, and dairy. Doctors sometimes call this increase in symptoms a “flare-up.”

But it can be hard to figure out exactly which foods trigger flare-ups in your case. That’s because the response to the trigger doesn’t usually happen right away. You might eat a particular food for weeks or months before it starts to cause a problem.

A food diary can help along with an “elimination diet” that bars certain foods from your diet to see how your body responds. Talk to your doctor about the best way to track the foods that could be triggering your EoE flare-ups.   

Doctors don’t yet understand all the long-term complications of EoE. They do know that in some people, EoE can start to scar the esophagus. This could narrow the esophagus and make it harder to swallow and more likely to trap food. This could cause serious issues like vomiting and choking.

At the same time, the inflammation of the esophagus also raises the chance that you could tear the tissue that lines the esophagus when you vomit or even when your doctor examines your esophagus with a special lighted camera called an endoscope. 

If you notice a serious flare-up of your EoE, it might be time to call your doctor. Symptoms that require medical attention include:

  • Problems swallowing
  • Unexplained weight loss
  • More unexplained vomiting
  • Stomach pain

Call 911 if you have:

  • Pain in your chest
  • Food stuck in your throat
  • A hard time talking or breathing