- Treatment options for eosinophilic esophagitis (EoE) include diet changes, medication, and procedures.
- You will have to balance your lifestyle and nutrition needs when deciding on a treatment plan with your care team.
- Finding the right treatment plan may take some trial and error.
Eosinophilic esophagitis develops due to abnormal immune system reactions that affect eosinophils, a type of white blood cell. In this condition, the esophagus (the tube that carries food from the throat to the stomach) becomes irritated and the number of eosinophils within the tissue increases. These immune cells create esophageal inflammation that leads to EoE symptoms such as dysphagia (trouble swallowing), food impaction (food stuck in the throat), chest pain, heartburn, and abdominal pain.
There are several treatments that may improve quality of life for people with EoE. Doctors may recommend diet changes, medication, and procedures. Many people use a combination of therapies. The treatment plan that works best can vary from person to person, so you may have to try several approaches before you find something that works for you.
Dietary Therapy for Eosinophilic Esophagitis
Sometimes, EoE can be managed by avoiding allergens (things that trigger allergic reactions), including certain foods and drinks. If changing your diet is helpful, you may be able to avoid taking medications that could cause side effects. On the other hand, it may be difficult to get proper nutrition and keep your body healthy if you need to eliminate too many foods.
Diets for EoE include:
- Food test-directed elimination diet — In this strategy, you undergo allergy testing to figure out which foods you are allergic to, and then eliminate those items from your diet.
- Empiric elimination diet without a food test — This diet includes avoiding all foods and drinks that most often cause allergic reactions, including wheat, dairy, eggs, peanuts, tree nuts, soy, fish, and shellfish.
- Elemental diet — This approach, which is more than 90 percent effective in the treatment of EoE, involves avoiding any foods or drinks that contain proteins and drinking a liquid containing amino acids (the building blocks of proteins).
It’s helpful to work with other health care providers, like an allergist or a dietitian, when planning a new diet. An allergist can perform testing to help determine your food allergies. Additionally, a registered dietician can assist in building a food elimination diet that meets all your nutritional needs and ensures you aren’t missing any important vitamins or minerals. Your gastrointestinal (digestive) specialist can refer you to these other providers.
Medications for Eosinophilic Esophagitis
EoE medications work in different ways to relieve symptoms or fight the underlying causes of the condition. Work with your doctor to find a drug type and dose that keeps your EoE under control.
Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are medications often used to treat gastroesophageal reflux disease (GERD), a condition in which stomach acid flows up into the esophagus. PPIs have two important roles — they lessen the amount of acid the stomach makes and they protect against inflammation. Both of these roles can help treat symptoms of EoE.
PPIs are often the first recommended treatment for EoE, but they don’t work for everyone. If you have tried these drugs and continue to have symptoms, your doctor may recommend other medications.
Topical Corticosteroids
Steroid medications, also called corticosteroids, decrease the activity of the immune system in order to reduce inflammation. Steroids can be either topical (medications applied directly to the affected area) or systemic (medications that travel throughout the bloodstream to all of the body’s tissues).
Eosinophilic esophagitis is most often treated with topical steroids, which have fewer side effects than systemic medications. In EoE, the affected tissue is the lining of the esophagus, so topical steroids are applied by swallowing them. Although no topical steroids are officially approved by the U.S. Food and Drug Administration (FDA) for EoE, two medications are known to help with this condition:
- Fluticasone (Flovent) — This medication is usually swallowed from an inhaler.
- Budesonide (Entocort EC) — This medication is a liquid that is typically eaten after forming a “slurry” with a thickening agent like Splenda, applesauce, or honey.
These medications both have similar effects in lowering the eosinophil count within the esophagus and helping people avoid EoE symptoms.
Biologic Medications
One biologic is FDA-approved to treat EoE — dupilumab (Dupixent). This medication was approved in 2022 for adults or adolescents 12 years old and up. It is a monoclonal antibody (protein that modifies part of the immune system) that can help prevent inflammation and damage within the esophagus.
One study found that 64 percent of people who took dupilumab had fewer EoE symptoms. People with EoE who took dupilumab were 10 times more likely to go into remission compared to those who received a placebo (a “fake” treatment that has no medical effects).
Additional clinical trials — research studies to evaluate treatments — are analyzing whether other biologic drugs may also help people with EoE. In the future, there may be additional medication options for this condition.
Procedures for Eosinophilic Esophagitis
EoE often leads to fibrosis (buildup of scar tissue) and strictures (narrowing) within the esophagus. This can make it more difficult for food to pass through.
Esophageal dilation is a procedure that can help widen the esophagus and make eating easier. You may choose to try this procedure if medications aren’t helping or if you don’t want to deal with their side effects.
Esophageal dilation is often performed at the same time as an upper endoscopy. During an endoscopic procedure, a long, thin tube with a camera is passed into the mouth, down the esophagus, and into the stomach or small intestines. An endoscopy can be used to take a biopsy (tissue sample), diagnose digestive system problems, or administer treatments such as esophageal dilation.
Esophageal dilations can be very effective, helping improve symptoms for 95 percent of people. However, they often need to be repeated multiple times to achieve the best results. Problems may also occur during a dilation — for example, it may lead to a perforation (hole or tearing) in the esophagus.
Esophageal dilation is particularly beneficial if there is a stricture in your esophagus. While serious problems occur less than 1 percent of the time with this procedure, the risk of perforation is increased for people who do not have a stricture.
Deciding on a Treatment Plan
To determine the optimal approach for treating your EoE, you may want to talk over the options with your primary physician as well as with other health care providers, such as your gastroenterologist, allergist, or dietitian.
It may take some trial and error before you find the right treatment plan. Make sure to attend all of your follow-up appointments, and let your health care team know if treatments don’t seem to be working or you experience any health changes.
Talk With Others Who Understand
On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to gain a new understanding of EoE and share their stories with others who understand life with EoE.
What treatments have you tried for eosinophilic esophagitis? Share your experience in the comments below.
References
- Eosinophilic Esophagitis — NORD
- Eosinophilic Esophagitis — Mayo Clinic
- EoE — American Partnership for Eosinophilic Disorders
- Eosinophilic Esophagitis — MedlinePlus
- Novel Therapeutic Approaches to Eosinophilic Esophagitis — Gastroenterology & Hepatology
- Eosinophilic Esophagitis — Johns Hopkins Medicine
- Eosinophilic Esophagitis — American Academy of Allergy Asthma & Immunology
- Corticosteroids — Cleveland Clinic
- Efficacy of Budesonide vs. Fluticasone for Initial Treatment of Eosinophilic Esophagitis in a Randomized Controlled Trial — Gastroenterology
- FDA Approves First Treatment for Eosinophilic Esophagitis, A Chronic Immune Disorder — U.S. Food and Drug Administration
- Mechanisms of Dupilumab — Clinical and Experimental Allergy
- Second Phase 3 Trial Shows Dupilumab Improves EoE in Patients 12 and Older — AJMC
- Upper Endoscopy — Mayo Clinic
FAQs
How long does it take to recover from eosinophilic esophagitis? ›
People with EoE may also be treated with oral or liquid steroids to decrease inflammation or with an immunomodulating medication. Many patients respond to these approaches within 6 to 8 weeks, their symptoms resolve, and they have no problem eating solid foods.
What is the new drug for EoE? ›A Breakthrough
DUPIXENT helps reduce EoE symptoms. DUPIXENT is a weekly injectable treatment given under the skin (subcutaneous injection).
The foods that most commonly cause an allergic reaction leading to EoE include milk, eggs, wheat, soy, peanuts or tree nuts and fish or shellfish. You may have a combination of allergies that increase the risk of EoE.
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.
Is EoE hard to live with? ›EoE Makes It Harder to Eat
Because it's hard to swallow, some children with EoE eat very little or they won't eat at all. This can make it hard for them to get the proper nutrition that they need to grow and develop. When EoE is severe, the esophagus can narrow so much that food gets stuck inside it.
EoE is not life threatening; however, if left untreated it may cause permanent damage to the esophagus. Many patients with EoE also experience gastroesophageal reflux disease (GERD), a chronic digestive disorder that is caused by the abnormal flow of gastric acid from the stomach into the esophagus.
What are the long term consequences 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.
How do you heal EoE naturally? ›Empiric elimination diet: An empiric elimination diet eliminates all major food allergens from the diet. These foods usually include dairy, egg, wheat, soy, peanuts, tree nuts, fish, and shellfish. These types of diets have been proven effective at treating eosinophilic esophagitis.
How do you stop an EoE flare up? ›Corticosteroids, which control inflammation, are helpful medications for treating EoE. Swallowing small doses of corticosteroids so they come into contact with and treat the inner lining of the esophagus is the most common treatment.
Is EoE a progressive disease? ›Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 inflammatory disease of increasing prevalence, characterized by symptoms of dysphagia and reduced quality of life.
Is EoE an autoimmune disease? ›
Eosinophilic esophagitis: an autoimmune esophageal disorder.
What foods make EoE worse? ›Multiple studies have found milk (60 percent) and wheat (30 percent) to be the most common food triggers.
What foods heal esophagitis? ›Use high protein, thick liquids and higher calorie items, such as milkshakes, custard, pudding, macaroni and cheese, etc. Some other soft or liquid-‐type foods are applesauce, cooked cereals, strained cream soup, mashed potatoes, Jello, rice pudding, etc.
Does EoE qualify as a disability? ›With eosinophilic esophagitis, a veteran may be eligible if they are awarded the 60 percent rating, OR if their rating for eosinophilic esophagitis helps them reach a combined rating of 70 percent. Veterans who do not meet these qualifications may be eligible for extraschedular TDIU.
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.
What happens if EoE goes untreated? ›Outlook for Patients With EoE
Based on what is known to date, eosinophilic esophagitis does not cause cancer of the esophagus and is not thought to limit life expectancy in any way. Current information suggests if left untreated, EoE may lead to esophageal narrowing over time.
The disease anxiety and choking anxiety subscales are also important contributors to HRQOL in adult EoE patients. In fact, a separate study found that disease anxiety and choking anxiety had the largest impacts on overall HRQOL in the EoE population.
Can you outgrow eosinophilic esophagitis? ›Current data suggests that patients do not outgrow this condition. Rather, EoE is thought of as a “relapsing and remitting” disease in which the inflammation typically returns if therapy is discontinued.
When should I go to the ER with EoE? ›Call your healthcare provider if you have EoE and notice any of these symptoms: Unexplained weight loss. Increasing or persistent vomiting. Stomach pain.
Does EoE run in families? ›Eosinophilic esophagitis can run in families but the risk for additional family members is <5% unless they are twins with the EoE patient. Several genes have been identified to contribute to EoE including CAPN14 and TSLP.
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.
What foods should be avoided with eosinophilia? ›Avoid all forms of fish and shellfish including fish sauce and oyster sauce. Read food labels and avoid foods that 'may contain' fish or shellfish. The following tables will show you what you can and can't eat while on the 6FED, avoiding wheat (W), milk (M), eggs (E), soy (S), nuts (N) and fish/shellfish (F).
What disease mimics EoE? ›Author disclosure: No relevant financial affiliations. Esophageal dysfunction, specifically gastroesophageal reflux disease (GERD), is commonly encountered in family medicine.
How many people in the US have eosinophilic esophagitis? ›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.
Is EoE caused by GERD? ›SS GERD increases the permeability of the esophageal mucosa. Food antigens that might have just passed through the esophagus to be digested in the stomach now might penetrate into the wall of the esophagus and incite an allergic response, conceivably contributing to the development of EoE.
Can eosinophilic esophagitis go into remission? ›Eosinophilic esophagitis (EoE) is a chronic disorder characterized by remissions and relapses. The goals of therapy in clinical care and research are to reduce eosinophil density below the threshold value for diagnosis, i.e. 15 eosinophils per high power field (HPF), and to reduce symptoms.
Is coffee good for eosinophils? ›In group 5 the caffeine increased the number of neutrophils 2.7-times and increased the number of eosinophils 4.6-times (P < 0.05) compared with control. Our study revealed that caffeine played an important role in the development of protective immune response.
Can EoE patients ever add foods back in? ›After about 8 weeks on a formula-only diet, your doctor will do an endoscopy to see if your eosinophil levels have gone down. If so, you'll slowly add foods back into your diet while your doctor monitors your body's response. The elemental diet is the most effective dietary approach to EoE.
Does Benadryl help with eosinophilic esophagitis? ›o Carry injectable epinephrine (Epi-Pen or Autoinjector) and an oral antihistamine such as Benadryl as prescribed for emergencies. If EoE is aggrevated by gastroesophageal reflux, treating the reflux may help the EoE. This may include medication, lifestyle, physical and dietary measures to decrease reflux.
Do probiotics help with EoE? ›Probiotics can be used as adjuvant treatment for patients with EoE. Improvement in the severity of chest pain and poor appetite and reduction in the frequency of nausea and poor appetite in these patients can be seen.
Is EoE related to Crohn's disease? ›
patients, investigators found a threefold to fivefold increased risk for EoE in patients with Crohn disease or ulcerative colitis compared with individuals without either disease.
Does EoE show up in blood work? ›Researchers have identified a biomarker in the blood that appears to reliably determine when milk is a trigger for eosinophilic esophagitis, a new study finds. EoE is the type of food allergy that causes inflammation and narrowing of the esophagus.
Can I drink coffee with EoE? ›Avoid foods and drinks that trigger heartburn.
Common triggers, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine, may make heartburn worse. Avoid foods that you know will trigger your heartburn.
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease limited to the esophagus and most often triggered by food allergens. Cow's milk is one of the most common foods causing EoE. Elimination of cow's milk protein from the diet is an effective non-pharmacologic treatment of cow's milk–mediated EoE (CMME).
What breakfast food goes with EoE? ›- Pumpkin Pie Chia Pudding - Hungry by Nature. ...
- Looking for a healthy breakfast idea? ...
- healthy flourless banana pancakes (gluten free, vegan) ...
- Strawberries and Cream Overnight Oats. ...
- Strawberry Banana Oatmeal Breakfast Smoothie Recipe | Yummly. ...
- Homemade Instant Oatmeal.
This can help prevent acid reflux symptoms. According to a 2019 case study , frequent sips of water can help clear acid from the esophagus. Beverages such as coffee, soda, and acidic juices may increase the risk or severity of reflux symptoms.
What drinks to avoid with esophagitis? ›Easily digestible foods are the best choice, as is avoiding carbonated drinks or beverages that are very hot or very cold. Your physician or nutritionist may further limit your intake of citrus, mint, or caffeinated drinks.
Do bananas help esophagitis? ›2. Bananas. This low-acid fruit can help neutralize stomach acid by coating an irritated esophageal lining. And not only are bananas alkaline, they're also rich in pectin — a soluble fiber that helps keeps food flowing nicely through the digestive tract.
Is EoE a rare disease? ›EoE is rare. But because it is a newly recognized disease, more people are now getting diagnosed with it. Some people who think that they have reflux (GERD) may actually have EoE.
Does EoE cause weight gain? ›Even though EoE may alter patients' diet due to structural changes in the esophagus, it does not significantly alter their weight.
Can EoE lead to Barrett's esophagus? ›
Conclusion: Surprisingly, our study suggests that eosinophilic esophagitis and gastroesophageal reflux disease confer a similar risk of developing Barrett's esophagus.
What happens if you don't treat eosinophilic esophagitis? ›In most cases, EoE develops as an allergic response to certain foods including wheat, milk, egg, soy, nuts, and seafood. If it is not properly diagnosed and treated, EoE may lead to permanent scarring or strictures (narrowing of the esophagus).
What happens if eosinophilic esophagitis is left untreated? ›Based on what is known to date, eosinophilic esophagitis does not cause cancer of the esophagus and is not thought to limit life expectancy in any way. Current information suggests if left untreated, EoE may lead to esophageal narrowing over time.
What foods should be avoided with EoE? ›The six-food elimination diet (SFED) is the most frequently employed dietary therapy in patients with EoE. This diet typically trials the exclusion of wheat, milk, egg, nuts, soy, fish and shellfish. An upper endoscopy and biopsy is performed after six weeks of the SFED diet.
What is the drug of choice for eosinophilia? ›Glucocorticoids are the most effective current therapy used to reduce eosinophil numbers in the blood and tissue (Table 1), but the pleiotropic effects of corticosteroids can result in potentially harmful side effects and limit their therapeutic use.
Can EoE be caused by anxiety? ›The disease anxiety and choking anxiety subscales are also important contributors to HRQOL in adult EoE patients. In fact, a separate study found that disease anxiety and choking anxiety had the largest impacts on overall HRQOL in the EoE population.
What triggers eosinophilia? ›Eosinophilia occurs when a large number of eosinophils are recruited to a specific site in your body or when the bone marrow produces too many eosinophils. This can be caused by a variety of factors, including: Parasitic and fungal diseases. Allergic reactions.
Is there a permanent cure for eosinophilia? ›This condition is chronic and recurring without a known cure. The current treatments and medications are meant to control the buildup of eosinophils and resulting symptoms. Talk with your doctor about the best plan for you. With the right treatment, you can reduce the discomfort in your throat.
What over the counter medicine can I take for eosinophilic esophagitis? ›Proton Pump Inhibitors (PPIs) – Many PPIs are available over-the-counter now, such as Prilosec and Nexium. These medications can help rule out GERD and sometimes reduce inflammation and reflux symptoms.