What Is Eosinophilic Esophagitis (EoE)?

EoE is a chronic (long-term) immune condition that affects the esophagus, the tube that connects your mouth to your stomach. EoE happens when a type of white blood cell called an eosinophil builds up in the lining of this tube. The buildup causes chronic inflammation (swelling) in the esophagus that can lead to symptoms of EoE.

When a person has EoE, their immune system floods the esophagus with white blood cells as a response to triggers such as certain food and environmental allergens, touching the lining of the esophagus. This abnormal response by the immune system is known as Type 2 inflammation.

Allergens like pollen, mold, dust and animal hair can trigger EoE. But the main cause of EoE are immune reactions to food.

Foods that can trigger EoE include:

• Dairy products
• Peanuts and tree nuts
• Wheat
• Seafood/shellfish
• Eggs
• Soy

Note: Not everyone with EoE reacts to the same foods, and testing cannot reliably predict which foods are triggers.

EoE looks different at different ages. Babies and young children may not want to eat and may spit up or vomit more frequently, have stomach pain, have disrupted sleep, and not grow properly.

For older kids and adults, the main symptoms of EoE are:

• Trouble swallowing
• Food getting stuck in the throat after swallowing (impaction)
• Heartburn
• Chest pain
• Stomach pain
• Food coming back up after swallowing (regurgitation)

These symptoms may come and go, flaring up only once in a while, or they may be constant. Even when you don’t have symptoms, you still have EoE because it is a lifelong, chronic condition.

Read: When My Son Was Diagnosed With EoE, Our Family’s World Was Turned Upside Down >>

EoE can affect anyone at any age, but certain risk factors may make a person more likely to have the disease. Your chances of having EoE are higher if you have:

• Food allergies
• Environmental allergies (pollen, dust, animal hair, etc.)
• Asthma
• Hay fever (allergic rhinitis)
• Eczema or other skin conditions that cause itchy, inflamed patches
• A family history of EoE or other allergic conditions

Because the symptoms of EoE are similar to those caused by other health problems that affect the esophagus, like gastroesophageal reflux disease (GERD) or a food allergy, it can be tricky to diagnose.

If your healthcare provider (HCP) thinks you may have EoE, they will send you to a gastroenterologist (GI doctor), which is a doctor who diagnoses, treats and manages diseases of the digestive system. They will look at your symptoms and do some tests, which may include:

• Upper endoscopy and biopsy: A long, skinny tube (endoscope) with a light and camera are used to view the lining of your esophagus and take samples to view under a microscope. An endoscopy and biopsy are required for an EoE diagnosis.

• Blood tests: Blood work is done to check for allergens, higher than usual eosinophil counts or other signs of allergic reactions. Note that blood tests alone cannot reliably diagnose EoE or food triggers.

• Esophageal sponge: A tiny sponge attached to a string is used to sample tissue in your esophagus without doing an endoscopy.

While there is no cure for EoE and it is a lifelong, chronic disease, it can be treated. Gastroenterologists treat and manage EoE. Allergists may also be part of your care team. While they cannot diagnose or treat EoE itself, they can help manage conditions that co-exist with EoE, such as food allergies.

The best treatment for you depends on your unique health situation. Some of the treatment options for EoE are:

• Diet changes like cutting out certain foods that could trigger EoE.

• Proton pump inhibitors (PPIs), which are medicines that lower the amount of acid your stomach makes.

• Steroids, which are medicines that help reduce inflammation. EoE is treated using liquid steroids that are swallowed so they come in direct contact with the lining of your esophagus to take down swelling.

• Biologics (monoclonal antibodies), a type of treatment that targets certain cells or proteins linked to inflammation, which reduces inflammation and improves swallowing.

• Esophageal dilation, a procedure that involves using an endoscopy to widen the esophagus to make swallowing easier, but does not treat the underlying inflammation. Dilation is usually used along with medications or dietary changes.

Treatments may change over time as your response and/or lifestyle change, so you should re-evaluate your treatment options with your HCP frequently. Since symptoms alone cannot determine whether you’re responding to treatment, repeated endoscopies and biopsies will be needed to measure your response to treatment and disease activity or progression. Together, you and your HCP can come up with a plan to treat your EoE on an ongoing basis.