GERD vs. EoE: Differences in Treatment | myEoEcenter (2023)

GERD vs. EoE: Differences in Treatment | myEoEcenter (1) GERD vs. EoE: Differences in Treatment | myEoEcenter (2)

  • Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) have similar symptoms. Both are diagnosed with upper endoscopy.
  • Proton pump inhibitors (PPIs) can be used to treat both GERD and EoE.
  • Biologic medications and steroids are used to treat EoE, but not GERD.

GERD vs. EoE: Differences in Treatment | myEoEcenter (3)

Eosinophilic esophagitis is a chronic immune condition that develops when a specific type of white blood cell — known as an eosinophil — builds up in the esophagus. As a result, the esophagus becomes inflamed and causes reactions to allergens, foods, or acid reflux.

Gastroesophageal reflux disease, on the other hand, is a condition caused by stomach acid entering the esophagus. This results in acid reflux that occurs at least a couple of times per week.

Since EoE and GERD have many of the same symptoms, they are often confused with one another. The methods of diagnosing these conditions and their treatments are similar as well.

How Are Eosinophilic Esophagitis and GERD Diagnosed?

Symptoms of EoE and GERD are similar, so making an accurate diagnosis of one or the other can be difficult. These symptoms include:

  • Trouble swallowing, known as dysphagia
  • Chest or abdominal pain, primarily caused by heartburn
  • Regurgitation of undigested food

People with EoE usually have difficulty swallowing. They might also experience food impaction, which occurs when food becomes stuck in the esophagus after swallowing.
GERD vs. EoE: Differences in Treatment | myEoEcenter (4)
The main symptom of GERD is heartburn. With longstanding heartburn, narrowing or strictures of the esophagus can lead to difficulty swallowing.

Both EoE and GERD can be diagnosed with an upper gastrointestinal (GI) endoscopy. In this procedure, a thin, flexible tube with a camera and light attached to the end is placed down into the esophagus. This helps doctors look for any abnormalities.

For people with EoE, the esophagus will develop bumpy rings or become narrow (known as a stricture), while GERD causes irritation and redness from stomach acid. It can be difficult to tell the difference, and a doctor may diagnose GERD instead of EoE.

To help differentiate between the two conditions, the doctor will also take a small piece of tissue during the upper endoscopy for an esophageal biopsy. A pathologist will look at the tissue under a microscope. The presence of eosinophils can confirm a diagnosis of EoE.

While EoE and GERD have similar symptoms, effective treatments vary between the two conditions. Some treatments that work for GERD may not always be effective for EoE.

First-Line Treatments for GERD

GERD is caused by stomach acid entering the esophagus, leading to heartburn and potential tissue damage. The main goal of treating GERD is to lower the amount of stomach acid produced or block its effects.

Proton Pump Inhibitors

The most common first-line treatment for GERD is proton pump inhibitors. These drugs work by limiting the amount of acid produced by the lining of the stomach, which can help alleviate GERD symptoms. PPIs are available over the counter or by prescription. Examples include:

  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)
  • Pantoprazole (Protonix)

PPIs are also used as a first-line treatment for EoE to reduce inflammation in the esophagus, often taken twice a day. However, because EoE is inherently an allergic condition caused by an overactive immune system, PPIs may not improve symptoms for some people.


Antacids are typically chewable tablets that neutralize stomach acid to help alleviate symptoms. These do not reduce the amount of stomach acid your body makes.

H2 Blockers

Similar to PPIs, H2 blockers also reduce stomach acid production to help treat GERD. Examples include famotidine (Pepcid or Zantac) and nizatidine (Axid).

Treatments for EoE

Treatments for EoE can include diet changes, medication, and procedures. Since EoE is a chronic immune condition, these treatments may be ongoing to help manage symptoms and control flares.

Dietary Changes

Your physician may want you to see an allergist to determine if you have any food allergies contributing to EoE. Recommended dietary changes may include eliminating any foods that trigger an allergic reaction.

Dietary therapy may have fewer side effects than taking medications or receiving endoscopic treatments. However, getting the nutrition you need could be difficult if you’re restricted from several large food groups, like wheat and dairy products. Your doctor or a dietitian can help you design a balanced diet.


Currently, the only medication approved by the U.S. Food and Drug Administration (FDA) specifically for treating EoE is the biologic Dupixent, a formulation of dupilumab. Approved in May 2022, Dupixent is used to treat EoE in adults and children ages 12 and up who weigh at least 88 pounds. This medication works by limiting inflammation in the esophagus, alleviating EoE symptoms.

In EoE, eosinophils found in the esophagus release inflammatory mediators known as cytokines. Biologic therapies target eosinophils, other immune cells that interact with them, or the cytokines they release. This category of medications has a lot of potential to treat EoE, but biologics are not approved to treat GERD.

GERD vs. EoE: Differences in Treatment | myEoEcenter (5)


While there is only one FDA-approved medication for treating EoE, other medications are prescribed off-label for treatment. Topical steroids are often used as a first-line treatment in favor of dietary therapy, specifically because diet changes may require multiple endoscopies over a short amount of time to assess how effective they are.

The two most commonly prescribed topical steroids for treating EoE are fluticasone and budesonide. These corticosteroids help reduce inflammation in the esophagus and may alleviate swallowing difficulties in as quickly as a few days.

Topical steroids can be either drunk as a liquid or placed in the mouth using an inhaler and then swallowed. Budesonide is given orally but has a bitter taste, so many people mix it into a smoothie with sweeteners such as honey or syrups. Fluticasone is placed in the mouth by using an inhaler twice daily.

While steroids may help treat EoE symptoms, they’re not helpful for GERD. Moreover, certain steroids may actually worsen heartburn in some people.

Endoscopic Procedures

Endoscopy is useful for diagnosing EoE, but it can also be used to treat symptoms of the condition.

Food Impaction

Between 33 percent and 55 percent of children and adults with EoE experience food impaction. This is when food becomes firmly stuck in the esophagus, preventing it from moving into the stomach. Food impaction is a medical emergency, and removal requires an endoscopy with specialized tools.


Adults and children with EoE can develop strictures in the esophagus. This occurs when the esophagus narrows, mainly due to inflammation and fibrosis. Fibrosis develops as a result of chronic inflammation, where the healing process replaces the cells that line the esophagus with collagen. As a result, the esophagus becomes scarred, thicker, and less flexible, leading to difficulty swallowing and, potentially, food becoming stuck.

To help widen these strictures, the esophagus can be dilated during an endoscopy. This dilation is done using wire dilators or balloons to widen the opening.

Which Treatment Option Is Right for You?

EoE is a complex disease that can be difficult to treat. Talk to a health care provider who specializes in gastroenterology about your options and which may work best for you. Some treatments, such as PPIs (which are also used for GERD), may not be as effective for you as for others. Each case of EoE is unique, so it’s important to work with your doctor to find which treatments are most effective.

GERD vs. EoE: Differences in Treatment | myEoEcenter (6)

Talk With Others Who Understand

On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to learn about EoE and share their stories with others who understand life with EoE.

Were you misdiagnosed with GERD before EoE? What treatments have you tried for eosinophilic esophagitis? Share your experience in the comments below.


  1. Eosinophilic Esophagitis — Mayo Clinic
  2. Gastroesophageal Reflux Disease (GERD) — Mayo Clinic
  3. Distinguishing GERD From Eosinophilic Oesophagitis: Concepts and Controversies — Nature Reviews Gastroenterology & Hepatology
  4. Eosinophilic Esophagitis — American Academy of Allergy Asthma & Immunology
  5. Diagnosis of GER & GERD — National Institute of Diabetes and Digestive and Kidney Diseases
  6. Upper GI Endoscopy — National Institute of Diabetes and Digestive and Kidney Diseases
  7. Eosinophilic Esophagitis: A Mimic of Gastroesophageal Reflux Disease — American Family Physician
  8. Proton Pump Inhibitors — MedlinePlus
  9. Taking Antacids — Medline Plus
  10. H2 Blockers — MedlinePlus
  11. Use of Dietary Strategies In Treating Eosinophilic Esophagitis — Mayo Clinic
  12. FDA Approves First Treatment For Eosinophilic Esophagitis, a Chronic Immune Disorder — U.S. Food and Drug Administration
  13. Controversies in Allergy: The Potential Role of Biologics as First-Line Therapy in Eosinophilic Disorders — The Journal Of Allergy and Clinical Immunology: In Practice
  14. Understanding Unapproved Use of Approved Drugs “Off Label” — U.S. Food and Drug Administration
  15. Topical Steroid Therapy for Eosinophilic Esophagitis — Gastroenterology & Hepatology
  16. Treatment of Eosinophilic Esophagitis With Swallowed Topical Corticosteroids — World Journal of Gastroenterology
  17. Prednisone (Oral Route) — Mayo Clinic
  18. Endoscopy in Pediatric Eosinophilic Esophagitis — Frontiers In Pediatrics
  19. Esophageal Food Impaction and Eosinophilic Esophagitis: A Retrospective Study, Systematic Review, and Meta-Analysis — Digestive Diseases and Sciences
  20. Esophageal Subepithelial Fibrosis in Children With Eosinophilic Esophagitis — Journal of Pediatric Gastroenterology and Nutrition


What is the difference between GERD and eosinophilic esophagitis? ›

Generally, GERD presents with heartburn and regurgitation, whereas EoE presents with episodes of dysphagia and food impaction. However, GERD can also cause dysphagia, and EoE can also cause heartburn.

What is the most effective treatment for eosinophilic esophagitis? ›

Your provider will likely first prescribe an acid blocker such as a PPI . This treatment is the easiest to use, but most people's symptoms don't improve. Topical steroid. If you do not respond to the PPI , your provider will then likely prescribe a steroid, such as fluticasone or budesonide.

Can you have both GERD and eosinophilic esophagitis? ›

Symptoms of heartburn, chest pain and dysphagia are recognized manifestations of both disorders, as is the presence of oesophageal eosinophilia. The prevalence of GERD in the general population (~20%) is sufficiently high enough to make coexistence of GERD with EoE inevitable.

What is the difference between GERD and esophagitis? ›

However, there are some differences between GERD and esophagitis. GERD is characterized by acid reflux. Esophagitis is characterized by inflammation, which is commonly caused by acid reflux and GERD. But there are many other possible causes of esophagitis.

Can you be misdiagnosed with EoE? ›

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.

Is eosinophilic esophagitis a symptom of GERD? ›

It wasn't until the 1990s that doctors realized that EoE isn't caused by GERD. It's a similar but totally separate condition. Eosinophilic esophagitis is a chronic immune system disease that has identical symptoms to the digestive disease GERD (gastroesophageal reflux disease), like trouble swallowing and chest pain.

How I cured my eosinophilic esophagitis? ›

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

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).

What happens if you don't treat eosinophilic esophagitis? ›

Complications. The long-term complications of EoE are not clearly understood. If left untreated, symptoms will continue and damage to the esophagus causing narrowing may happen.

What are the most common EoE triggers? ›

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.

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.

Does stress affect eosinophilic esophagitis? ›

Increased stress can worsen symptoms.

Can your esophagus heal after GERD? ›

Acid reflux, hiatal hernias, vomiting, complications from radiation therapy, and certain oral medications are among the reasons the esophagus can develop inflamed tissue. Esophagitis can usually heal without intervention, but to aid in the recovery, eaters can adopt what's known as an esophageal, or soft food, diet.

Does GERD always damage esophagus? ›

According to the National Institute of Diabetes and Digestive and Kidney Diseases , only a small percentage of people with GERD develop Barrett's esophagus.

How do you treat inflamed esophagus from GERD? ›

Depending on the type of esophagitis you have, you may lessen symptoms or stop recurring problems by following these steps:
  1. Do not eat foods that may increase reflux. ...
  2. Use good pill-taking habits. ...
  3. Lose weight. ...
  4. If you smoke, quit. ...
  5. Try not to stoop or bend, especially soon after eating.
  6. Do not lie down after eating.
Nov 29, 2022

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.

What mimics eosinophilic esophagitis? ›

Eosinophilic esophagitis (EE) is characterized by eosinophilic infiltration of the esophageal mucosa and results in clinical signs and symptoms that may be indistinguishable from those of gastroesophageal reflux disease (GERD).

How long can an EoE flare up last? ›

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 commonly mistaken for GERD? ›

Heartburn-like pain is a common symptom of gastroesophageal reflux disease (GERD), but several other conditions can cause a burning feeling in your chest, including gallstones, stomach ulcer and esophageal cancer.

How do you identify EoE triggers? ›

Allergists may do a series of different allergy tests to identify the foods causing EoE. Foods such as dairy products, egg, soy and wheat are main causes of EoE. However allergies to these foods often cannot be easily proven by conventional allergy tests (skin tests, patch tests or blood tests).

How do I get my EoE into remission? ›

Corticosteroids are another effective therapy for the treatment of EoE[70,71]. the formulation of the most commonly used corticosteroids, including budesonide, fluticasone propionate, and ciclesonide, influences histological remission.

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.

What foods decrease eosinophils? ›

Eat a healthy diet free of acidic foods: Both acid reflux and heartburn can raise your body's eosinophil count. To avoid these conditions, one must eat a balanced, healthy diet. Look for low-fat foods, including lean meats, whole grains, fresh fruits and vegetables, and whole-grain foods.

Does Pepcid help 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.

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.

Does Benadryl treat EoE? ›

Does Benadryl Relieve Eosinophilic Esophagitis? Benadryl, a diphenhydramine formulation, is an antihistamine acting against allergies. It was not found effective against eosinophilic esophagitis.

Is EoE manageable? ›

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.

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.

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.

Why is EoE on the rise? ›

What Causes EoE? According to Dr. Gramling, the rise in EoE cases found in children is likely due to increasing allergies of all types and improved awareness about the disorder.

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 EoE cause permanent damage? ›

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.

How rare is eosinophilic esophagitis? ›

The frequency of eosinophilic esophagitis has been estimated to be approximately 1 in 2,000 individuals.

Does EoE run in families? ›

Eosinophilic esophagitis (EoE) is a chronic, allergic disease associated with marked mucosal eosinophil accumulation. Multiple studies have reported a strong familial component to EoE, with the presence of EoE increasing risk for other family members with EoE.

What does high eosinophils feel like? ›

Vomiting. Abdominal pain. Difficulty swallowing, also called dysphagia. Food getting stuck in the esophagus after swallowing, also known as impaction.

What age does eosinophilic esophagitis start? ›

Although EoE typically presents in school-age children (6-12 years) and young adults (third-fourth decade of life),16 it can also present in infancy (<_12 months).

How do you know if your esophagus is damaged from GERD? ›

Difficulty swallowing. Painful swallowing. Swallowed food becoming stuck in the esophagus, also known as food impaction. Chest pain, particularly behind the breastbone, that occurs with eating.

How long does it take for GERD to heal in the esophagus? ›

Although healing of the esophagus may occur in 6 to 8 weeks, it should not be misunderstood that gastroesophageal reflux can be cured in that amount of time. The goal of therapy for GERD is to keep symptoms comfortably under control and prevent complications.

How long does it take for omeprazole to heal esophagitis? ›

The cumulative healing rates in the initial healing period on omeprazole 20 mg daily were: 77% at four weeks; 87% at eight weeks; and 95% at 12 weeks (table 3). Fourteen of 15 patients unhealed after 12 weeks received omeprazole 40 mg daily for a further 12 weeks; 13 healed at the end of this period (table 3).

What's the longest GERD can last? ›

It can vary. For some folks, it can last just a few minutes. Sometimes it can last for several hours. Heartburn happens about once a week for up to 20% of Americans and is common in pregnant women.

What are red flags for GERD? ›

Alarm symptoms include dysphagia (difficulty swallowing) and odynophagia (painful swallowing), which may represent presence of complications such as strictures, ulceration, and/or malignancy. Other alarm signs and symptoms include, but are not limited to, anemia, bleeding, and weight loss.

Will I have GERD forever? ›

Yes, GERD can be cured. The most common treatment for Gastroesophageal Reflux Disease is medication, which can help to decrease the amount of acid in your stomach. If lifestyle changes don't help, your doctor may also recommend surgery.

How long does it take for esophagus inflammation to go away? ›

It might take 1 to 3 weeks to heal. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems.

How long does it take for GERD to turn into Barrett's esophagus? ›

This method connected the jejunum to the esophagogastric anastomosis in rats to induce reflux of gastric acid and duodenal fluid into the esophagus, creating a condition similar to that of human esophageal reflux. Barrett's esophagus developed after 20 wk, while esophageal adenocarcinoma appeared after 40 wk[72].

What foods soothe 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.

What is the most common cause of eosinophilic esophagitis? ›

Causes. EoE is caused by an allergic reaction to certain foods or environmental allergens.

What foods to avoid if you have eosinophilic esophagitis? ›

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.

Can you have esophagitis without GERD? ›

A: Yes, although GERD is a common cause of esophagitis, it is possible to develop GERD without also developing esophagitis. There is debate over whether this should be considered a sub-entity of GERD or a condition of its own called non-erosive reflux disease (NERD).

How many Americans 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. EoE affects more adults than children (19.1 cases/100,000 vs.

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.

Can probiotics help eosinophilic esophagitis? ›

Conclusion. 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.

What vitamin is deficient in EoE? ›

When the researchers examined a cohort of patients with EoE, they found that many of these patients had a vitamin D deficiency, Rothenberg said. Biopsies revealed that the severity of their disease, including eosinophil levels, histological changes and other features, were inversely proportional to vitamin D levels.

Can your esophagus heal from GERD? ›

Acid reflux, hiatal hernias, vomiting, complications from radiation therapy, and certain oral medications are among the reasons the esophagus can develop inflamed tissue. Esophagitis can usually heal without intervention, but to aid in the recovery, eaters can adopt what's known as an esophageal, or soft food, diet.


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