EoE is believed to be caused by allergies to food and perhaps environmental triggers. 

Eosinophils are not normally found in the esophagus, although they may be found in small numbers in other areas of the gastrointestinal tract. Gastroesophageal reflux disease (GERD), drug reaction, and inflammatory bowel disease (Crohn’s disease) can also cause elevated numbers of eosinophils. 

The eosinophils cause injury to the surrounding tissues. 

People with EoE often have other allergic conditions such as nasal and eye/ocular allergies, asthma, anaphylactic food allergies, and/or eczema. EoE can be triggered by delayed reaction to foods and in some cases is inherited. 

Symptoms of EoE vary among individuals and age groups. Vomiting may occur more commonly in young children while older individuals may have difficulty swallowing. Food impactions are more common in adults and adolescents.

What is an Eosinophil?

Eosinophils are a type of white blood cell that are part of our immune system, helping us to fight off certain types of infections. 

Many different medical conditions can cause a person to have too many eosinophils including allergies (food and environmental), parasites, and certain cancers.

Symptoms 

People with EoE commonly have the following symptoms, which may vary with age:

• Reflux

  
  

• Difficulty swallowing 

  
  

• Food impactions (food gets stuck in the esophagus) 

  
  

• Nausea and vomiting 

  
  

• Failure to thrive (poor growth, malnutrition, or weight loss) 

  
  

• Abdominal or chest pain 

  
  

• Feeding refusal/intolerance or poor appetite

  
  

Diagnosis

To diagnose EoE, a gastroenterologist will perform an upper endoscopy. This procedure is typically not uncomfortable and can be done on an outpatient basis.

During this procedure, the patient is sedated or put under anesthesia, and a small tube called an endoscope is inserted through the mouth. The esophagus, stomach, and the first part of the small intestine are examined for tissue injury and inflammation, and the esophageal wall is examined for thickening. A patient may have EoE even if the esophagus looks normal during endoscopy.

Small tissue samples are taken (biopsies) for a pathologist to analyze under a high-powered microscope. If eosinophils are present in the samples, the pathologist will count how many are visible.

An endoscopy with the biopsies is the only reliable method of diagnosing EoE at this time, although less invasive diagnostic and monitoring methods are currently under investigation.

Treatment

Current treatment options for EoE include swallowed topical corticosteroid therapy (fluticasone or a budesonide mixture/slurry), proton-pump inhibitors (acid suppressors), elimination diet therapy, or a combination of these therapies. Dupilumab (Dupixent®) is a therapy that was recently approved in the U.S. as indicated treatment for EoE in patients aged 12 and older. Repeat endoscopies with biopsies are needed to monitor the effectiveness of the treatment plans. 

Diet management may include: 

• Common allergen elimination diet – Common allergy-causing foods (milk, egg, soy, wheat and, at times, other foods such as shellfish, fish, peanuts/tree nuts based on current studies) are removed from the diet, rather than using food allergy test results to determine which food(s) to remove. 

  
  

•  Elemental diet – All sources of protein are removed from the diet and the patient drinks only an amino acid formula. Sometimes, a feeding tube may be required.

  
  

• Food trial – Specific foods are removed from the diet, and then added back, one at a time, to determine which food(s) cause a reaction.

  
  

Medications may include: 

• Topical steroids – Swallowed from an asthma inhaler or mixture, to control inflammation and suppress the eosinophils. 

  
  

• Proton pump inhibitors (PPIs) – May help reduce inflammation and control acid production.

Do Adults get EoE?

Yes. EoE affects the entire age spectrum, from infants to adults. Some adults have had symptoms since childhood and are diagnosed later in life, and others first develop symptoms later in life. Adults are more likely to have problems with food “sticking” in the throat (food impactions). 

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

APFED, apfed.org 

Eosinophil.Connect patient registry, apfed.org/registry 

EOS Connections, inspire.com/groups/eos-connections/