Understanding Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is an allergic condition that causes inflammation of the esophagus, the tube that carries food from your mouth to your stomach. Because EoE is usually triggered by food allergies, removing certain foods from your diet often eliminates choking problems, food impaction, and other risks.
Eosinophilic esophagitis occurs when the immune system responds to an allergen, such as dairy foods or wheat, and overloads the lining of the esophagus with a type of white blood cell called eosinophils. As a result, the esophagus becomes irritated, inflamed and narrowed, causing difficulty swallowing and other symptoms, including getting food stuck in your throat – called food impaction. By working with a gastroenterologist and an allergist, you may be able to identify problem foods or other allergens. Your treatment team can also help you develop a plan that may include dietary changes and medications to reduce inflammation.
Symptoms of EoE can vary somewhat depending on the age in which they first appear. More than two-thirds of EoE cases first develop in childhood. Most of the remaining cases first present when people are in their 30s and 40s.
Infants with eosinophilic esophagitis tend to display the following symptoms:
- refusal to take a bottle or breastfeed
- frequent spitting up and/or vomiting
- arching of the back (a sign of physical distress)
Older children with EoE may:
- eat slowly
- show abnormal aversion to specific foods
- have trouble sleeping
- fail to grow or gain weight on a healthy timeline
- complain of heartburn and/or abdominal pain
Adults with EoE often have the following symptoms:
- difficulty swallowing (dysphagia), usually with solid foods
- food impaction (food actually getting stuck in the esophagus)
- acid reflux that doesn’t improve with antacid medications
- chest pain
Eosinophilic esophagitis symptoms stem from the damage caused to the esophagus. When the esophagus becomes inflamed, it can lead to difficulty swallowing both solid food and fluids. EoE can sometimes cause the esophagus to narrow, raising the risk of food impaction, a serious choking hazard. Over time, rings may develop around the inside of the esophagus, further raising the risk of choking.
While the exact cause of EoE isn’t certain, it appears that genetic and environmental factors may both be involved. In some cases, allergies to pollen, mold, or other substances in the air may trigger EoE symptoms. But for the most part, food allergies are to blame.
Some of the most common foods that cause EoE flare-ups are:
- seafood, including shellfish
- peanuts and tree nuts
Because EoE symptoms often mirror that of gastroesophageal reflux disease (GERD), it can sometimes be challenging to get an accurate diagnosis. A doctor should get your medical history, a detailed accounting of when you experience symptoms, and what those symptoms are. Consider keeping a food diary to help pinpoint food allergies.
To understand what’s happening in the esophagus, your doctor will likely perform an endoscopy. It’s considered the most important EoE test to get a proper diagnosis.
During the procedure, the doctor will pass a thin, flexible tube (endoscope) containing a miniature light that’s attached to a camera at the other end. This allows the doctor to visually inspect the esophagus to check for signs of inflammation. A tiny piece of biopsy tissue may be painlessly removed to check for eosinophils.
EoE is a chronic condition for which there is currently no cure. And it’s one that shouldn’t go untreated, even if symptoms are mild. A 2022 study suggests that, if left untreated, EoE will progress, leading to a narrowing of the esophagus called stricture that can raise the risk of food impaction and reduce quality of life.
Because food allergies are usually at the root of eosinophilic esophagitis, the best treatment is to eliminate all common triggers from your diet. If symptoms improve, your doctor may advise you to add one food at a time back into your diet to see if symptoms return. This is called an elimination diet.
Other treatment options may include special topical steroids that can be swallowed in liquid form to ease inflammation along the inner wall of the esophagus. Two commonly prescribed steroids include budesonide (Tarpeyo) and fluticasone.
You may also be advised to try proton pump inhibitors (PPIs), which are oral medications that reduce stomach acid levels. PPIs aren’t approved for EoE, but because they can help lower the risk of esophageal irritation, many doctors prescribe them off-label for EoE. Additionally, the U.S. Food and Drug Administration (FDA) recently approved a biologic medication called dupilumab (Dupixent) for EoE treatment.
An endoscopy procedure may also be performed to stretch a narrowed section of the esophagus – a treatment known as esophageal dilation.
By partnering with your gastroenterologist or allergist, you can find a path forward to managing EoE, reducing the risk of food impaction or choking, and enjoying meals again.