Eosinophilic Esophagitis

Do you have trouble swallowing food? Does food sometimes get stuck in your throat? Do you have to drink a large amount of liquid just to get food down? A yes to any of these questions suggest you may have a chronic condition called eosinophilic esophagitis (EoE).

EoE affects about one in 2,000 people, according to the American College of Allergy, Asthma & Immunology (ACAAI). EoE can be triggered by a food allergy. Some people who think they have gastroesophageal reflux disease (GERD) may actually have EoE.

What is eosinophilic esophagitis?

Eosinophilic esophagitis (EoE) is a chronic condition. It occurs when an increased number of cells called eosinophils cause inflammation and swelling in the esophagus. This can make it difficult to swallow food.

What are symptoms of eosinophilic esophagitis?

Symptoms will depend on age.

In infants and young children, symptoms may include:

• refusal to eat
• abdominal pain
• reflux
• vomiting
• poor growth

In teenagers and adults, symptoms may include:

• difficulty swallowing
• reflux
• chest pain
• food getting slightly stuck in the throat

If you have any of these symptoms, you may have eosinophilic esophagitis.

People with EoE tend to cut their food into tiny pieces, over-chew food, or drink excessive amounts of liquid to get food down.

It’s important to note that if food does get stuck in the throat, this is a potential medical emergency and people should go to the hospital immediately.

What causes eosinophilic esophagitis?

Doctors and researchers are not sure what causes it. In some people, EoE is triggered by food or by environmental allergens such as pollen and mold.

Who develops eosinophilic esophagitis?

EoE occurs in both children and adults. It’s common to see it in more males than females. It’s prevalent in families that have a history of allergic disease.

How is EoE diagnosed?

A doctor will perform a biopsy.  – inserting a small tube, or endoscope, through the mouth to examine the esophagus and stomach and take small tissue samples. There may be visible swelling, lacerations, ulcers or nodules in the esophagus.

Many people experience EoE symptoms for years and never see a doctor. They may come to think it’s normal to have food get slightly stuck in the throat or experience pain as they swallow.

How is EoE treated?

There are three ways to manage eosinophilic esophagitis:

• diet therapy
• medication
• a combination of both

Diet therapy

Your diet can trigger or worsen EoE symptoms. Sometimes the food is obvious and you can avoid that food. Sometimes it is tough to pinpoint exactly which food or category of foods is causing symptoms. 

Diagnostic tests such as skin tests, blood tests and patch tests to identify EoE trigger foods are no longer recommended. The results are difficult to interpret for EoE and do not always match symptoms.

Instead, an elimination diet is recommended. In an elimination diet, you try a series of foods, adding and removing them from the diet. Then you observe if symptoms improve or worsen. For older children and adults, an elimination diet may involve common food allergens: milk, peanut, tree nuts, eggs, wheat, soy and all seafood. The food groups are then reintroduced one at a time.

Managing EoE in infants and young children follows a similar method. The diet is limited to a non-allergenic, amino acid-based formula at first. Then other foods are slowly added to the diet, followed by observation for worsening EoE.

Elimination diets should only be done under the guidance of a physician. Adhering to diet therapy is critical. It may be helpful to see a nutritionist or dietician to find replacement foods and ensure nutritional needs are met.

Medications

Since EoE is an inflammatory disease, the mainstay of therapy is to decrease inflammation in the esophageal tissue.

Your doctor may prescribe:

Proton pump inhibitors (PPIs)

These reduce acid production in the stomach. They have been found to also reduce esophageal inflammation in some EoE patients. PPIs are often used as a first treatment for EoE. Some respond well to PPIs and see a decline in the number of eosinophils and inflammation. However, not all EoE patients respond to PPIs.

Corticosteroids

These medications help control inflammation. They can be given as an inhaled medication or as a liquid that is swallowed. As the esophageal tissue heals, the dosage can decrease.

Biologics

Dupilumab (brand name: Dupixent®) is currently the only FDA-approved treatment for EoE. It works by blocking proteins called interleukin-4 and interleukin-13. This decreases eosinophils in the body and can reduce inflammation or stop inflammation before it can start. The medication can also improve patients’ ability to swallow food.

Dupilumab is an injectable medication that is administered weekly. It’s prescribed to adults and children ages 12 and older weighing at least 88 pounds.

Patient Resources

• American Partnership for Eosinophilic Disorders (APFED) 
• Campaign Urging Research for Eosinophilic Disorders (CURED)

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Reviewed by:

Jacqueline Eghrari-Sabet, MD, FACAAI, is board-certified in allergy, immunology and pediatrics. She serves as the Medical Director of Telehealth for Allergy & Asthma Network. Dr. Eghrari-Sabet is the founder of Family Allergy & Asthma Care and the FAAR Institute in the Washington, DC area, where she has been in private practice since 1994. Dr. Eghrari-Sabet is Assistant Clinical Professor at George Washington University School of Medicine and Health Sciences. She is also President of White Coat Resources, a health education consulting service.

Matthew Greenhawt, MD, FACAAI, is a board-certified pediatric allergist and immunologist. He serves as associate professor of pediatrics-allergy/immunology at the University of Colorado School of Medicine. He is also director of the Food Challenge and Research Unit at Children’s Hospital Colorado. Dr. Greenhawt went to medical school at Tufts University School of Medicine and earned a Masters of Science degree at University of Michigan.