Eosinophilic Esophagitis: Symptoms, Causes, and Treatment

How medications and dietary changes help control this rare inflammatory disorder that affects the esophagus.

People who have eosinophilic esophagitis may have difficulty swallowing.

Eosinophilic esophagitis is an inflammatory condition that affects the esophagus, the muscular tube located in the upper torso that connects the throat to the stomach. Eosinophilic esophagitis is commonly referred to as EoE.

What are the symptoms of eosinophilic esophagitis?

People who have eosinophilic esophagitis may have symptoms such as pain in the chest or pain that feels like heartburn, difficulty swallowing, getting food stuck in the throat when swallowing, abdominal pain, and vomiting.

However, the symptoms will vary from person to person, often depending on a person’s age. The condition affects people of all ages, including infants, children, and adults.

Some of the symptoms of eosinophilic esophagitis overlap with another condition called gastroesophageal reflux disease (GERD), which is more common than eosinophilic esophagitis. There are diagnostic tests that can determine whether symptoms are being caused by GERD, eosinophilic esophagitis, or another esophageal condition.

What causes eosinophilic esophagitis?

The exact cause of eosinophilic esophagitis is unknown. It is considered an allergic disorder and a disorder of the immune system, where exposure to environmental factors—foods, pollen, dust mites, animal dander—trigger the release of white blood cells called eosinophils, which cause inflammation in the esophagus. Some tests used to diagnose eosinophilic esophagitis look for eosinophils in the esophagus or in the blood.

What healthcare providers treat eosinophilic esophagitis?

Diagnosing and treating eosinophilic esophagitis can involve working with several different healthcare providers with different specialties—allergic diseases, gastroenterology, and for people under the age of 18, pediatric medicine. A healthcare team may also include surgeons, registered dietitians, and healthcare providers who specialize in mental health.

How is eosinophilic esophagitis diagnosed?

Diagnosis may include endoscopy (a medical device used to examine the esophagus) and a biopsy of the affected area. Medical history is also important to diagnosis, including any history of allergies and allergic reactions, and other health conditions, such as eczema and asthma.

How is eosinophilic esophagitis treated?

There is no known cure for eosinophilic esophagitis, and treatment for the condition focuses on control and management. This includes addressing flare-ups of inflammation when they occur, and identifying and avoiding triggers that cause flare-ups. Medications that are used to treat eosinophilic esophagitis include:

  • Proton pump inhibitors (PPIs). These medicines work by reducing the amount of acid in the stomach and are used to treat GERD, ulcers in the upper GI tract, and damage to the esophagus caused by refluxing acid. These can help with symptoms and inflammation.
  • Corticosteroids. Corticosteroids are anti-inflammatory medicines used to treat a wide variety of conditions. The corticosteroids used to treat eosinophilic esophagitis can be given in a liquid solution or inhaled, which allows the drug to be absorbed into the tissues of the esophagus.
  • Monoclonal antibody therapy. There is also a monoclonal antibody therapy that has been approved for the treatment of eosinophilic esophagitis, and more are under development. An antibody is a protein made by the immune system that helps the immune system eliminate harmful substances. A monoclonal antibody is a lab-made version of an antibody. These are injected into the body, and work by binding to and blocking specific inflammatory cells, helping to reduce inflammation.

In addition to medications, healthcare providers may also recommend dietary changes, such as an elimination diet, which can help identify foods and beverages that trigger flares. Any dietary changes should always be done under the guidance of a healthcare provider.

Article sources open article sources

National Organization for Rare Disorders. Eosinophilic Esophagitis.
Johns Hopkins Medicine. Eosinophilic Esophagitis.
MedlinePlus. Eosinophilic Esophagitis.
Steven Clayton and John F. Emerson. Eosinophilic Esophagitis: A Mimic of Gastroesophageal Reflux Disease. American Family Physician, 2018. Vol. 97, No. 10.
Jordan M. Roussel and Sudha Pandit. Eosinophilic Esophagitis. StatPearls. August 8, 2022.
Mayo Clinic. Eosinophilic Esophagitis.
Northwestern Medicine. The Esophageal Program.
U.S. Food & Drug Administration. FDA Approves First Treatment for Eosinophilic Esophagitis, a Chronic Immune Disorder.
Cleveland Clinic. Monoclonal Antibodies.
Hani Harb and Talal Chatila. Mechanisms of Dupilumab. Clinical & Experimental Allergy, 2020. Vol. 5, No. 1.

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