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Your Guide to Eosinophilic Esophagitis

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Why Eosinophilic Esophagitis Can Be Confused with GERD

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C

Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) both affect the esophagus. In GERD, digestive acid backs up from the stomach into the esophagus. EoE is an immune condition that causes inflammation in the esophagus.

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GERD and EoE share common symptoms, like heartburn, chest pain, and trouble swallowing. These overlaps sometimes make the two conditions hard to tell apart, even for doctors. Confusing the matter even more is that some people with EoE feel better when they take the proton pump inhibitors (PPIs) used to treat GERD.

Because these two conditions are so similar, it’s important to work with your doctor to get the proper diagnosis.

What is eosinophilic esophagitis?

EoE is a relatively rare condition that affects only about 1 in 2,000 people. It makes the immune system extra sensitive to allergens like food, dust, or pollen.

When you’re exposed to an allergic trigger, large numbers of white blood cells called eosinophils multiply in the lining of your esophagus and cause inflammation. An inflamed esophagus is what produces symptoms like heartburn and trouble swallowing.

What is GERD?

GERD is a much more common condition in which stomach acid often backs up into the esophagus. Up to 1 in 5 people in the United States have GERD. Other names for it are acid reflux, reflux, or acid indigestion.

The backup of acid causes symptoms like heartburn, nausea, and chest pain. Untreated GERD can cause inflammation called esophagitis and damage in the esophagus.

Differences and similarities

GERD and EoE have different causes. EoE is caused by a faulty immune response to allergens in the environment. GERD happens when the band of muscle that prevents acid from backing up from the stomach into the esophagus doesn’t close properly.

In EoE, eosinophils multiply in the esophagus lining. Some people with GERD also have these white blood cells but in much smaller numbers.

GERD and EoE have similar symptoms, which is why they are so easy to confuse. Both conditions can cause:

  • heartburn
  • regurgitation — bringing up undigested food into the esophagus
  • trouble swallowing
  • food stuck in the esophagus

The difference is that GERD is more likely to cause heartburn and regurgitation, while EoE more often causes trouble swallowing and food stuck in the esophagus.

GERD might lead to EoE, and vice versa. Inflammation from GERD creates tiny holes in the esophagus lining. Those holes allow allergens to slip into the esophagus and cause a reaction. Eosinophils in EoE release substances that weaken the muscles that prevent acids from backing up into your esophagus.

Acid-lowering drugs called proton pump inhibitors (PPIs) are one of the main treatments for GERD. PPIs also work for some, but not all people with EoE.

Differences between EoE and GERD

EoEGERD
Main symptomsTrouble swallowing, food stuck in the esophagusHeartburn, bringing up undigested food
Ages affectedChildren and young adultsMiddle-aged adults and older
Gender affectedMostly maleAll genders
Eosinophils in the esophagusLarge numbersNone or small numbers
Endoscopy findingsSwelling, narrowing, or furrowing of the esophagusSores, damage, narrowing of the esophagus
CauseImmune response against allergensBackup of acid from the stomach
Main treatmentsSteroids, elimination diet, possibly PPIsPPIs, H2 blockers, antacids

How do doctors tell GERD and EoE apart?

A gastroenterologist can diagnose GERD and EoE. Symptoms alone may not be enough to confirm which of the two conditions you have because there is so much overlap. The only way to get a sure diagnosis is with an endoscopy and biopsy.

During an endoscopy, your doctor places a flexible tube with a camera on one end into your esophagus to look for inflammation. The doctor removes small pieces of tissue from the esophagus lining for the biopsy. Eosinophils and inflammation on the biopsy are signs of EoE.

Allergy testing is also part of the diagnosis for EoE. Your allergist may use blood tests or skin testing to figure out which allergens are causing your symptoms.

Treatments

Treatments for EoE aim to stop the allergic reaction and reduce inflammation in the esophagus. GERD treatments reduce the amount of acid your stomach makes and help your esophagus heal.

EoE medications include:

  • Dupixent (dupilumab) is the only Food and Drug Administration-approved medication for treating EoE. It’s a once-a-week injection that reduces inflammation and improves swallowing.
  • PPIs are acid-lowering medicines that also reduce inflammation in the esophagus.
  • Corticosteroids reduce inflammation in the lining of the esophagus.

These medicines only relieve symptoms of EoE. An elimination diet is the only way to prevent the allergic reaction that causes symptoms. Your allergist can help you determine which foods are triggering your EoE, so you can avoid them.

GERD treatments include:

  • PPIs, histamine type 2 (H2) blockers, and antacids to reduce the amount of acid your stomach makes.
  • Lifestyle changes such as diet, weight loss, and quitting smoking can sometimes reduce GERD symptoms.
  • Surgery to strengthen the valve that holds acid in your stomach may relieve GERD if lifestyle changes and medication don’t improve your symptoms enough.

How to avoid confusion

Symptoms like heartburn, chest pain, and trouble swallowing are more likely to be GERD because they are more common. See a doctor if treatments like PPIs, antacids, or H2 blockers don’t relieve your symptoms. You may need more tests to determine if EoE or another condition is behind your symptoms.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2023 Mar 17
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