What is eosinophilic esophagitis (EoE)?

Eosinophilic esophagitis (EoE) is a chronic (long-term) allergic disease that affects the esophagus – the tube that carries the water and food you swallow to the stomach. When you have EoE, eosinophils, a type of white blood cell, build up in the lining of the esophagus.

Allergies, mainly to foods, cause this buildup, and it can lead to swelling, injury, and inflammation.

With EoE, swallowing can become difficult, or you might feel like food is getting stuck in your throat.(1)

Scientists know that EoE is closely linked to inflammation. EoE is a type 2 inflammatory disease that happens when the body has a strong reaction to certain allergens that are usually not harmful. (2) When these allergens touch the esophagus, the immune system in the lining of the esophagus sends signals to bring in special cells from the blood and other tissues. These cells – mostly white blood cells called eosinophils – are called upon to fight the allergens. But if too many eosinophils come, they can damage the tissue of the esophagus.(1)

Anyone can get EoE, but it is more common in males, people with other allergic conditions, and those who have family members with EoE.

Common symptoms of EoE depend on the person’s life stage.(3)

Adults:
● Trouble swallowing
● The feeling of food getting stuck in the throat
● Acid reflux that does not feel better with medicine
● Slow eating

Children:
● Abdominal or chest pain
● Vomiting
● Poor appetite
● Reflux that does not feel better with medication
● Difficulty swallowing

Infants and Toddlers:
● Not gaining enough weight
● Vomiting
● Reflux
● Problems with feeding

EoE can significantly affect the daily lives of those with the condition as well as their caregivers. Individuals with EoE often experience reduced quality of life (4) and heightened levels of anxiety and depression. (5) People with the condition may avoid eating and situations in which they may experience symptoms in front of others. (6) Employment or school attendance may also be impacted.

It is important to communicate any emotional health symptoms to a healthcare professional to ensure they are included in your overall treatment and management plan.

Caregivers of individuals with chronic conditions like EoE may experience heightened stress, isolation, anxiety, and depression. If experiencing these feelings or symptoms, it is essential to seek support to avoid caregiver burnout. Joining a support group, reviewing trusted caregiver resources, and engaging your friends and family network are all ways to reduce the stress of caregiving.

If food allergens cause your EoE, avoiding certain foods can help prevent your symptoms.

An elimination diet – where you remove foods purposely from your diet at different times – is created by a specialist doctor or a nutritionist and can help you find out which foods trigger your EoE. Some elimination diets focus on removing the most common triggers for several weeks until your symptoms improve. The most common food allergens include milk, wheat, eggs and soy. After avoiding some of these foods for several weeks, inflammation could have gone, and you can add them to your diet one at a time. Your healthcare provider may want an endoscopy (scope) with a biopsy to check for inflammation after adding foods back into your diet. (7)

In the past, allergy testing was used to determine your food allergies. However, this strategy was poorly effective in identifying foods causing EoE, therefore it is not recommended currently to treat most patients with EoE.(3)

Doctors sometimes recommend medication to reduce inflammation (you can think of this as swelling within the body). (3,7)

  • Corticosteroids: These medicines help lower swelling and irritation in your body. They do this by calming down your immune system when it gets too active. Doctors may use topical formulas of corticosteroids if your esophagus is swollen.
  • Proton Pump Inhibitors (PPIs): These medicines were developed to reduce the acid your stomach makes. However, they also have an anti-inflammatory effect independent from the anti-acid one. PPIs help stop inflammation allowing your esophagus to heal.
  • Biologics (Monoclonal Antibodies): These are newer medicines that go after the parts of your immune system causing swelling. If your immune system is making your esophagus swell too much, biologics can help reduce it so swallowing feels better.
  • Esophageal dilatation: If, as a consequence of a long lasting inflammation, your esophagus has narrowed, in addition to an anti-inflammatory treatment, your doctor may increase your esophageal caliber through an endoscopy with dilation.

Talk to your healthcare professional about the best option for you.

World EoE Day

World Eosinophilic Esophagitis (EoE) Day is observed annually on May 22nd to raise awareness about this chronic and often misunderstood condition. For more information on this awareness day and how to get involved, visit EoEday.org and follow on social media using the hashtag #EoEDay.

Registry

EoE Connect (EU)

Citations

  1. Muir A, Falk GW. Eosinophilic Esophagitis. JAMA. 2021;326(13):1310-1310. https://doi.org/10.1001/jama.2021.14920
  2. Chehade M, Falk GW, Aceves S, et al. Examining the Role of Type 2 Inflammation in Eosinophilic Esophagitis. Gastro Hep Advances. 2022;1(5):720-732. https://doi.org/10.1016/j.gastha.2022.05.004
  3. Gold BD, Goodwin B, Davis K, et al. Health-Related Quality of Life and Perceived Stigma in Eosinophilic Esophagitis: A Real-World, US, Web-Based Survey. Gastro Hep Advances. 2024;3(8):1087-1097. https://doi.org/10.1016/j.gastha.2024.07.015
  4. Taft TH, Guadagnoli L, Edlynn E. Anxiety and Depression in Eosinophilic Esophagitis: A Scoping Review and Recommendations for Future Research. Journal of Asthma and Allergy. 2019;Volume 12:389-399. https://doi.org/10.2147/jaa.s193045
  5. de E, Floor Bennebroek Evertsz, Lei A, Bredenoord AJ. General Well-being and Coping Strategies in Adult Eosinophilic Esophagitis Patients. Journal of Neurogastroenterology and Motility. 2022;28(3):390-400. https://doi.org/10.5056/jnm21143
  6. ‌Eosinophilic Esophagitis: What it Is, Symptoms & Treatment. Cleveland Clinic. Published August 29, 2023.
  7. Accessed March 24, 2025. https://my.clevelandclinic.org/health/diseases/14321-eosinophilic-esophagitis

Content Reviewed by GAAPP’s Scientific and Advisory Panel