Eosinophilic Esophagitis (EoE)

What Is Eosinophilic Esophagitis?

Eosinophilic Esophagitis, also known as EE or EoE, is a chronic allergic/immune condition that causes inflammation or swelling of the esophagus — the tube that sends food from the throat to the stomach. Inflammation occurs when white blood cells called eosinophils gather in the lining of the esophagus, a place where they usually are not found. This chronic inflammation leads to symptoms.

What are the Symptoms of Eosinophilic Esophagitis?

Symptoms can vary with age:

  • Adults and teens will report difficulty swallowing
  • School age children might complain of abdominal pain, as well as trouble swallowing and regurgitation of food
  • Infants and toddlers may refuse food or not grow properly

A major concern with EoE is food impactions, where the esophagus constricts to the point that food gets trapped. This is a medical emergency and requires immediate attention.

This condition can occur at any age but for reasons yet unknown, impacts more males than females. Allergists and gastroenterologists have seen a significant increase in the numbers of people diagnosed with eosinophilic esophagitis in the past decade.

EoE can be triggered by a food allergy, acid reflux, or an airborne (seasonal) allergy. If left untreated, symptoms cause further damage to your esophagus and, potentially, your overall health.

Who is at Risk for Eosinophilic?

Most people with EoE are atopic meaning they have symptoms of one or more allergic disorders. These allergic conditions include allergic rhinitis, asthma, atopic dermatitis (eczema), and food allergy. About half of people with EoE also have seasonal allergies or asthma and notice their EoE symptoms get worse during the times of the year they experience seasonal allergy symptoms. Others may have food allergies or eczema, and some have a combination of allergic conditions that increase the risk of EoE. About one in four people who have food allergy-induced EoE notice a seasonal variation in their symptoms.

In some cases, there is a genetic component, so having a family member with EoE can also be a risk factor.

Diagnosis and Treatment

How Do You Diagnose and Treat Eosinophilic Esophagitis?

EoE is a complex disorder that often requires a gastroenterologist and an allergist/immunologist working together to confirm the diagnosis and develop the proper treatment and management plan.

Currently an upper endoscopy and biopsies of the esophagus conducted by a gastroenterologist are necessary to confirm a diagnosis of EoE. This involves passing a flexible tube containing a light source and a camera lens down your throat to allow your doctor to see the tissue more clearly. Tiny samples of tissue can be collected to detect levels of eosinophils.

An allergist will determine what role allergies are playing in your condition. Along with a thorough history of symptoms, they will often utilize allergy testing during the diagnostic process. Allergy skin prick tests can identify sensitivity to environmental allergens like pollen, mold, pet dander, and dust mites.

The main cause of EoE in many patients is an adverse immune response to food. If food(s) are suspected, eliminating the most common triggers may be recommended to see if symptoms improve. Common food triggers include dairy, eggs, peanuts, other tree nuts, wheat, fish and shellfish, and soy products. If allergy testing identifies other food allergies, eliminating those foods may be recommended as well. With EoE, it can be more difficult to establish the role caused by foods since reactions are slower, and a single food may be harder to pinpoint.

Medical Therapy

The treatment prescribed will depend on what is triggering your EoE and the severity of your symptoms. Medications to reduce eosinophils in the esophagus may be utilized. Proton pump inhibitors (PPI's) reduce acid production in the stomach or swallowed inhaled steroids to control inflammation. Careful monitoring by physicians knowledgeable in treating EoE is important.

In May 2022, the FDA approved the use of Dupixent (dupilumab) in adults and children 12 years and older for treating eosinophilic esophagitis. This is the first medicine to be approved for EoE treatment. This injectable biologic medication reduces inflammation associated with the disease improving the ability to swallow.

There is no cure for EoE, but with an accurate diagnosis and proper management by your gastroenterologist and allergist, your symptoms can be controlled, greatly improving your quality of life.

If you are experiencing any symptoms related to EoE, schedule an appointment with one of our allergist/immunologists for an evaluation.