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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), dysphagia (difficulty swallowing), and gastroesophageal reflux disease (GERD). Less common symptoms include 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 in EoE is a high number of eosinophils, a type of white blood cell, infiltrating the surface lining of the esophagus. Normally eosinophils are not usually found in this area.

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 commonly known to cause inflammation from the diet guided by a registered dietitian
  3. ‘Topical’ steroidal anti-inflammatories (typically twice daily) to coat the esophagus and turn off inflammation
  4. Esophageal dilation (stretching esophageal narrowing associated with scarring)

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.