- Eosinophilic esophagitis (EoE) symptoms are caused by inflammation and narrowing of the esophagus, which makes eating and swallowing difficult.
- Symptoms of EoE vary by age group, with different symptoms occurring in infants, children, adolescents, and adults.
- Knowing the symptoms of EoE may help ensure you receive a correct diagnosis and begin effective treatments as soon as possible.
Eosinophilic esophagitis is a chronic immune condition that results in inflammation of the esophagus. This inflammation is caused by an excess of immune cells, known as eosinophils, in the esophageal tissues. This leads to symptoms such as dysphagia (difficulty swallowing), food impaction (food getting stuck in the esophagus), and reflux (stomach acids entering the esophagus). EoE can affect infants, children, and adults. Symptoms can present differently among age groups, making the condition difficult to diagnose.
Oftentimes, EoE is misdiagnosed as gastroesophageal reflux disease (GERD) before it’s correctly diagnosed as EoE. Knowing the symptoms of EoE can help point your doctor to a correct diagnosis so you can start effective treatments.
What Causes Eosinophilic Esophagitis Symptoms?
EoE is an inflammatory condition caused by a specialized type of white blood cell known as an eosinophil. Eosinophils play an important role in the immune system: They release chemicals to help fight off harmful organisms like parasites. These cells move to areas of inflammation to help other immune cells trap and kill invaders. Although eosinophils are generally beneficial, they’re also responsible for causing allergy and EoE symptoms.
People living with EoE have higher levels of eosinophils in their bloodstream and esophagus, compared to those without the condition. When eosinophils become overactivated or too numerous, they release too many chemicals into the bloodstream, which activates immune cells. This brings in more cells and creates too much inflammation, which can damage the body’s healthy tissues.
Allergies to substances such as pollen, pet dander, or certain foods can trigger this reaction. When you eat food or inhale air that contains an allergen, it comes in contact with the esophagus. The tissues in the esophagus then become inflamed. This inflammation can eventually cause the esophagus to narrow. This, in turn, can cause symptoms such as food impaction or swallowing difficulties.
Symptoms of Eosinophilic Esophagitis
Symptoms of EoE are mainly caused by narrowing of the esophagus from inflammation. Also known as a stricture, this narrowing is associated with rings forming in the esophagus, which make it more difficult for food to travel down into the stomach. In some cases, tissue that lines the esophagus can tear, especially in situations where food gets stuck.
Age plays a large role in what symptoms occur in EoE cases.
EoE Symptoms in Infants, Children, and Adolescents
Pediatric cases of EoE look different than those in adults. In many cases, getting an infant or young child who’s diagnosed with EoE to eat can be difficult. This may result in a medical condition known as failure to thrive, which means a child isn’t getting enough nutrients to gain weight and grow. A child may lose weight as a result. Some younger children with EoE may also be extra sensitive to certain foods or textures, making it difficult for them to eat.
Children and teenagers may also experience:
- Dysphagia (trouble swallowing)
- Nausea
- Vomiting
- Abdominal pain
These symptoms make eating food — especially solid food — and keeping it down difficult. Food can get stuck in a person’s esophagus. This food impaction can be dangerous if the food isn’t vomited up. If left untreated, it can become a medical emergency.
Infants and children of all ages may experience reflux, where stomach acid enters the esophagus. This may cause a burning sensation or warmth in the chest and neck area. A doctor may misdiagnose these symptoms as GERD and prescribe treatment with proton pump inhibitors (PPIs). Although PPIs can sometimes successfully treat EoE, they also sometimes fail and symptoms will continue. The ongoing symptoms may cause a doctor to re-evaluate their original GERD diagnosis and could eventually lead to a correct EoE diagnosis.
EoE Symptoms in Adults
Adults share some symptoms of EoE with younger people, but they also have a few distinct symptoms. Similar symptoms include:
- Dysphagia
- Food impaction, especially with solid, dry foods that are difficult to swallow
- Stomach pain
- Vomiting
Additionally, adults can experience more intense acid reflux than children, which causes heartburn and pain in the center of the chest.
Adults with EoE rarely show signs of failure to thrive or weight loss. Loss of appetite and disinterest in eating are also less common.
If you notice you’re experiencing EoE symptoms several times a week or if they’re severe, talk to your doctor. If you take heartburn medications frequently, tell your doctor, as it may point them to an EoE diagnosis.
Other Conditions Associated With Eosinophilic Esophagitis
People with EoE often have other related health conditions which involve overactivation of the immune system. Examples include atopic dermatitis (eczema), asthma, and other food or environmental allergies. If you’re diagnosed with one or more of these health issues, you may be at a higher risk of having EoE. Not everyone with EoE has one of these other conditions, but between 50 percent and 80 percent do.
Seasonal and food allergies are both connected to EoE. Some people may even notice their EoE symptoms worsen during allergy season or after eating certain foods. This is because eosinophils are directly involved in both conditions. An allergist may offer allergy testing, such as skin or blood tests, to determine which substances cause a reaction.
Eczema and asthma also may involve an excess of eosinophils. People living with eczema may have too many eosinophils in their bloodstream and skin. In asthma, there can be too many of them in the bloodstream and lungs after a flare. Having too many eosinophils can affect other parts of the gastrointestinal system, including the intestines and stomach.
Talk to Your Doctor About Your Symptoms
If you’re experiencing any of the symptoms of EoE, talk to your doctor. They may perform tests and refer you to specialists to help accurately diagnose your condition. Typically, a gastroenterologist or an allergist helps diagnose EoE. Talking to your doctor is the first step in getting the treatment you need.
To help correctly diagnose EoE, these doctors may run some tests to help rule out other conditions and confirm a diagnosis. These include an upper endoscopy and a biopsy. An upper endoscopy involves taking pictures of the esophagus with a small camera so that the specialist can see what is happening inside. A biopsy involves taking tissue samples, which a health care worker will view under a microscope to count the number of eosinophils present.
Although there’s no cure for EoE, many treatment options are available to help target inflammation at its source and address symptoms. Treatment options that help alleviate symptoms of EoE include:
- PPIs
- Topical corticosteroids
- Diet plans, such as the elemental diet or elimination diet
- Esophageal dilation, which helps expand the esophagus
Currently, dupilumab (Dupixent) is the only medication approved by the U.S. Food and Drug Administration (FDA) specifically for treating EoE. This drug works by directly targeting the inflammation created by eosinophils in the esophagus to help alleviate symptoms and treat the condition.
Find Your Team
On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to learn more about EoE and share their stories with others who understand life with EoE.
What symptoms have you or a loved one experienced while living with EoE? Share your experiences in the comments below.
References
- Eosinophilic Esophagitis — Mayo Clinic
- What Is an Eosinophil? — Cincinnati Children’s
- EoE — American Partnership for Eosinophilic Disorders
- Eosinophilic Esophagitis (EoE) — American Academy of Allergy Asthma & Immunology
- Eosinophilic Esophagitis in Children — Boston Children’s Hospital
- Eosinophilic Esophagitis — MedlinePlus
- Eosinophilic Esophagitis — NORD
- Eosinophilic Esophagitis — American Academy of Allergy Asthma & Immunology
- Eosinophilic Esophagitis: A Mysterious Allergic Disease — Stanford Medicine
- What Is Eosinophilia? — Cincinnati Children’s
- FDA Approves First Treatment for Eosinophilic Esophagitis, A Chronic Immune Disorder — U.S. Food and Drug Administration
- Use of Dietary Strategies in Treating Eosinophilic Esophagitis — Mayo Clinic
FAQs
Can EoE be misdiagnosed? ›
Unfortunately, because symptoms develop gradually, EoE is often misdiagnosed, or not caught at all until after tissue damage to the esophagus has already taken place.
What can mimic EoE? ›Because symptoms of EoE are similar to gastroesophageal reflux disease (GERD) it is important to be assessed by both an allergist and a gastroenterologist to get an accurate diagnosis.
How do I confirm my EoE? ›Currently, eosinophilic esophagitis is diagnosed by upper endoscopy and biopsy. The endoscopy sometimes reveals rings (Figure 1), white plaques (patches) (Figure 2), or furrows in the esophagus (Figure 3); however, EoE may be present even if the esophagus looks normal. That's why we take biopsy samples.
What is the most common symptom related to eosinophilic esophagitis? ›The symptoms of eosinophilic esophagitis are variable, especially in people of different ages. Common symptoms include difficulty swallowing (dysphagia); food getting stuck in the throat (impaction); nausea; vomiting; poor growth; weight loss; stomach pain; poor appetite; and malnutrition.
Can EoE be missed on endoscopy? ›Upon urgent endoscopy for a patient with food impaction, adhesion of food residues on the esophageal mucosa, or reflux of gastric contents into the esophagus, may prevent clear observation by the endoscopist, even after impacted food removal from the esophagus; thus, they may potentially miss EoE diagnosis.
How many eosinophils does it take to diagnose EoE? ›A count of 15 or more eosinophils per high-powered microscopic field is highly suggestive of EoE. A patient may have EoE even if the esophagus looks normal during the endoscopy. The biopsies will help in making an accurate diagnosis.
What does an EoE flare up feel like? ›Vomiting. Abdominal pain. Difficulty swallowing, also called dysphagia. Food getting stuck in the esophagus after swallowing, also known as impaction.
Do EoE symptoms come and go? ›Older children and adults may experience reflux, chest pain, stomach pain, and trouble swallowing. The symptoms can occur days or even weeks after eating a food allergen. But symptoms may also come and go.
What autoimmune diseases are associated with EoE? ›Recent studies have found higher rates of autoimmune diseases, such as celiac disease, Crohn's disease, and ulcerative colitis, in patients with eosinophilic esophagitis (EoE) than in the general population.
Where is EoE pain located? ›If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain and may lead to trouble swallowing and food getting stuck in your throat. EoE is rare.
Does EoE always show up in biopsy? ›
If the biopsies show at least 15 eos/hpf, then the diagnosis of EoE is a possibility, but it is not confirmed. The other causes of esophageal eosinophilia, in particular GERD and PPI-REE must be assessed, which is best done by treating with a high dose PPI trial for 8 weeks.
How long do EoE symptoms last? ›People with eosinophilic esophagitis have intermittent episodes of food getting stuck in the esophagus for a few minutes to a few hours. This may cause chest or upper abdominal pain, persistent heartburn, and a backflow of undigested food (regurgitation).
What autoimmune diseases cause high eosinophils? ›- Acute myelogenous leukemia (AML)
- Allergies.
- Ascariasis (a roundworm infection)
- Asthma.
- Atopic dermatitis (eczema)
- Cancer.
- Churg-Strauss syndrome.
- Crohn's disease.
During endoscopy, the diagnosis of EoE cannot be made unless esophageal biopsies are obtained.
Is EoE constant? ›EoE is considered to be a chronic condition that can be medically managed, but is not outgrown. Eosinophils can be found in the esophageal tissue in diseases other than EoE. One common example is acid reflux disease.
Can you have EoE with negative biopsy? ›Conclusion: A false negative result on biopsy, in patients with true EE, may occur in late stage disease secondary to a burn out phenomenon associated with fibrosis. In addition, immunocompromised patients may have a false negative result secondary to impairment in the recruitment of eosinophils.
What is considered mild eosinophilia? ›The degree of eosinophilia associated with different conditions can be characterized as mild, (500–1500 eosinophils per microliter), moderate (1500–5000 eosinophils per microliter), or severe (greater than 5000 per microliter). The term hypereosinophilia refers to eosinophil levels above 1500.
What level of eosinophils indicate allergies? ›Eosinophilia (see text box), defined as a peripheral blood eosinophil count greater than 450 cells per microliter, is associated with numerous disorders including allergies, drug reactions, helminth infections, Churg-Strauss syndrome [glossary], some malignancies and metabolic disorders, eosinophilic gastrointestinal ...
What level of eosinophils indicate high? ›A count of more than 500 eosinophils per microliter of blood is generally considered eosinophilia in adults. A count of more than 1,500 eosinophils per microliter of blood that lasts for several months is called hypereosinophilia.
What is the best EoE treatment? ›The two most common EoE treatment methods are dietary therapy and medication. Because food allergies trigger this condition, many kids with EoE need to watch what they eat to control their symptoms. Medication can help reduce inflammation in the esophagus, allowing food to more easily pass through it.
What is the best drink for esophagitis? ›
Drinking water, low fat milk, and herbal teas may help manage it. Alcohol, caffeinated drinks, and sodas may worsen symptoms, however. Acid reflux, or heartburn, occurs when stomach acid flows up into a person's esophagus, or food pipe. It is common for people to experience acid reflux intermittently.
Is EoE progressive? ›Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 inflammatory disease of increasing prevalence, characterized by symptoms of dysphagia and reduced quality of life.
What is a long term complication of EoE? ›Over time, EoE can leave permanent damage and scars in your esophagus that make it hard to eat. The stress of living with a chronic disease can be hard on your emotional health, too. There's no cure for EoE, but proper treatment, which usually includes medicine and changes to your diet, can keep it under control.
Does stress affect EoE? ›Increased stress can worsen symptoms.
How many people suffer from EoE? ›Prevalence and Consequences: EoE prevalence has increased over the past 2 decades, nearly doubling in both adults and children, and occurring in an estimated one in 1,500 to 2,000 persons. EoE affects more adults than children (19.1 cases/100,000 vs.
What causes EoE flare ups? ›The most common allergens that cause EoE to flare are milk, eggs, soy and dairy. But it can be hard to track due to the nature of how the flare ups occur. “With something like a peanut allergy the response is immediate,” said Robson. “But with EoE it is more of a delayed reaction.
Can high eosinophils mean nothing? ›Eosinophilia happens when your body produces too many eosinophils. Eosinophils are one of several white blood cells that support your immune system. Many times, people learn they have eosinophilia when they have routine blood tests. A high eosinophil count typically isn't a cause for alarm.
What kind of doctor treats eosinophilia? ›If you think you have eosinophilic esophagitis, you're likely to start by seeing your regular health care provider. Your provider may recommend that you see a specialist in treating digestive diseases (gastroenterologist) or an allergist.
What cancers are associated with eosinophilia? ›Eosinophilia is uncommon in healthy individuals, however, it is associated with allergies, helminth infections and some inflammatory states. Eosinophilia has also been observed in cancer, including colorectal, breast, ovarian, cervical, oral squamous, Hodgkin's lymphoma and prostate cancer.
Can EoE be misdiagnosed as GERD? ›The symptoms of EoE, which can include regurgitation, difficulty swallowing, a burning sensation, nausea, and vomiting, can be very difficult to distinguish from GERD. Many people who are suffering from EoE are initially told that they have reflux disease.
Can EoE disappear? ›
There is no cure for EoE. Treatments can manage your symptoms and prevent further damage.
Can Pepcid help with EoE? ›Commonly, the pain is presumed to be heartburn, burning in the chest or abdomen, but it does not improve after taking antacids (Tums, Rolaids, Zantac, Pepcid, etc.). In younger children, EoE is suspected when feeding problems or poor growth are discovered.
What causes an EoE flare up? ›The most common allergens that cause EoE to flare are milk, eggs, soy and dairy. But it can be hard to track due to the nature of how the flare ups occur. “With something like a peanut allergy the response is immediate,” said Robson. “But with EoE it is more of a delayed reaction.