Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis (EoE) is a chronic allergic disease of the esophagus — the tube leading from the mouth to the stomach. It is most common in children and young adults compared to infants. It is characterized by food impaction (food stuck in the throat, neck or chest), dysphagia (difficulty swallowing or feeling food pass slowly), vomiting, and gastroesophageal reflux disease (GERD). Less common symptoms include poor growth, food aversion, cough or throat clearing with eating, regurgitation of food, chest discomfort with eating, slow eating, increased fluids to wash down solids, and requiring small bites or excessive chewing.

Diagnosis of EoE requires upper endoscopy with multiple esophageal biopsies. This procedure is performed by a gastroenterologist under general anesthesia, supervised by an anesthesiologist. The characteristic finding on esophageal biopsies in EoE is a high number of eosinophils (at least 15 per high power field), a type of white blood cell, infiltrating the surface lining of the esophagus. Often the esophagus looks abnormal with vertical lines (furrows), paleness (edema), white specks (exudate), rings (developing scar tissue), or stricture (scar tissue that has progressed to narrowing). Eosinophils may not be found in areas of scarring.

Most children with EoE have one or more foods in the diet that is causing the inflammation with eosinophils. However, symptoms occur due to chronic inflammation secondary to chronic exposure to inciting food(s), and cannot be readily identified by history, nor blood or skin testing. Left untreated, scarring can develop in the esophagus, which can lead to esophageal food impaction (food trapped in the esophagus) necessitating emergent endoscopy.

The current standard-of-care treatment options for EoE in children are:

1. Proton pump inhibitors (PPI) such as omeprazole or lansoprazole
2. Removal of foods from the diet commonly known to cause inflammation with the guidance of a registered dietitian
3. ‘Topical’ corticosteroids (typically twice daily) such as fluticasone or budesonide to coat the esophagus and turn off inflammation
4. Dupixent injections weekly, which blocks the Interleukin 4 receptor, critical to driving the inflammation
5. Esophageal dilation (stretches esophageal narrowing associated with scarring) guided by EndoFLIP (identifies and measures esophageal narrowing)

Learn more about eosinophilic gastrointestinal diseases in the Division of Gastroenterology, Hepatology & Nutrition (Digestive Disorders) and the Eosinophilic Gastrointestinal Diseases Program.

Learn more about food elimination diets.