What Is Eosinophilic Esophagitis?

Written by Sylvia Davis, Marijke Vroomen Durning, RN
Medically Reviewed by Sanjay Ponkshe, MD on May 16, 2025
12 min read

Eosinophilic esophagitis (EoE) is a chronic disease that causes inflammation to your esophagus, the tube that connects your mouth and stomach. It’s related to  chronic allergies to either food or something in the environment. As your esophagus becomes inflamed or damaged, it can be painful and hard to swallow. This can lead to complications like malnutrition and poor growth.

The disease was only identified in the early 1990s and while more and more people are being diagnosed with EoE, it's still considered a rare condition. Researchers estimate that it affects between 30 and 55 out of 100,000 people in the United States and Europe, although it might be as high as 112 out of 100,000, according to a Spanish study. It often starts when you're a child, between ages 6 and 12, or young adult, in your 20s or 30s. But you can get it at any age.

 

The symptoms of EoE depend on if it’s affecting an infant or small child, or a teen or adult.

What is the first sign of EoE?

The first signs of EoE in infants and young children include:

  • Vomiting
  • Refusing to nurse or eat
  • Failure to thrive, which means they aren’t gaining weight and growing as they should

For older children, teens, and adults, first signs usually are:

  • Difficulty swallowing, called dysphagia
  • Poor appetite
  • Heartburn (reflux) that doesn’t improve with medication
  • Pain or discomfort in the chest
  • Decreased appetite (school-age children)
  • Refusal to feed (infants/toddlers)

Other symptoms of EoE

There might be other symptoms if you have EoE. They could be:

  • Nausea and vomiting
  • Food getting stuck in your esophagus, called food impaction
  • Difficulty sleeping because of the discomfort
  • An itchy throat when you eat
  • A feeling of a lump in your throat when you eat, called globus

Your esophagus is part of your gastrointestinal tract, or GI tract, which runs from your mouth right through your body to your anus. EoE has similar symptoms to another GI disease, gastroesophageal reflux disease (GERD).  Before EoE was recognized as a separate illness, if you had it, your doctor probably thought you had GERD. 

How long do symptoms last?

EoE is a long-time, chronic illness, so symptoms typically last for your whole life. They might go away with treatment but can return if the treatment stops working or you stop taking it.

 

Eosinophils are a type of white blood cell. They’re part of your immune system, working to protect you from parasites, allergens, and other microbes, like bacteria. Eosinophils are usually found in your blood, bone marrow, fat (adipose tissue), lungs, skin, and stomach. If they get into the wall or lining of your esophagus – where they’re not supposed to be – they release a substance that causes inflammation in the tissues. As the inflammation grows, it can lead to damage, which causes eosinophilic esophagitis.

Scientists aren't sure exactly why this happens to some people. It could be a reaction to certain foods or substances in your environment. It might also run in families. Researchers have found some genes that might have a role in causing EoE.

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Anyone can get EoE, but some people are at higher risk of developing it. They include people who have:

Food allergies. This seems to be one of the biggest risk factors for EoE, affecting almost 20% of people with the disease. Some experts have said that EoE may actually be a form of chronic food allergy. Up to half of people with EoE associated with food allergies have one food that causes the disease, one-third have two foods that are triggers, and the rest have three or more. Milk is the most common culprit, which means that any dairy product, like cheese, could cause problems. The other most common foods that trigger EoE include:

  • Eggs (more among children than adults)
  • Wheat
  • Peanuts
  • Tree nuts
  • Soy
  • Legumes
  • Fish and shellfish

Other allergies. Dust mites, pollen, mold, and other environmental substances can be triggers.

Atopic/allergic rhinitis (hay fever). Almost half of people with EoE have hay fever.

Asthma. About 27% of people with EoE also have asthma.

Atopic dermatitis (eczema). About a quarter of people with EoE have eczema.  

Sex. More people who are male have EoE than those who are female. 

Family history. There may be a genetic link.

Climate. The disease seems to be more common in cold or dry areas.

Seasons: Flares are more common in the spring, summer, and fall.

Many EoE symptoms are the same ones for GERD, so your doctor will have to rule out acid reflux or any other possible cause before giving you a diagnosis.

The first step is talking to you, asking about your:

Eating habits. Do you avoid certain foods that you find make things worse? Do you prepare your food in certain ways so it’s easier to swallow?

Medical history. Have you been diagnosed with conditions that are often related to EoE, like asthma, allergies (food and environment), or eczema?

Family’s medical history. Does a close biological family member have EoE? Once your doctor has this information, you might be referred for testing. 

Endoscopy. An endoscope, a long tube with a light and camera on the end, is placed in your mouth and eased down into your esophagus. This allows the doctor to see what your esophagus looks like. They’re looking for inflammation, white spots, rings, and areas where the esophagus is narrower than it should be (a stricture). If the signs are there, it’s not a definite diagnosis yet though. You would need more tests to be sure.

Biopsy. A biopsy is a test that can be done during the endoscopy. The doctor takes a small piece of tissue with the endoscope and sends it to a lab to be looked at through a microscope to see if there are eosinophils. 

Blood tests. Blood tests can tell if you have higher levels of eosinophils in your body or a protein called immunoglobulin E, which could mean you have allergies.

Allergy tests. Allergy tests, skin pricks on  your skin to test for trigger foods, may help you identify which foods you might be allergic to.

Esophageal sponge. To do this test, you swallow a capsule that has a sponge in it and a string attached to it. When the capsule is in your stomach, the coating breaks down, releasing the sponge. The doctor then uses the string to pull the sponge out. As the sponge comes up through your esophagus, it collects a sample of tissue. 

What to do when you’re first diagnosed

When you’re diagnosed with EoE, you might feel relieved because you finally have a diagnosis, but you also might feel a bit overwhelmed with learning how to deal with the condition. You’ll probably be working closely with a specialist to get your symptoms under control. 

 

 

Your care team depends on where you are and what health care professionals are available to you. In general, the professionals who might be on an EoE care team could be a:

  • Gastroenterologist, a specialist in GI diseases and usually the primary person for treating EoE
  • Allergist, a specialist in allergies
  • Ear, nose, and throat doctor (otolaryngologist), a specialist in diseases and conditions that affect your ears, nose, and throat
  • Nurse practitioner, a nurse with advanced training who specializes in a specific area of health care
  • Internist, a specialist in internal medicine, usually complex medical conditions
  • Primary care doctor, a doctor who practices general health care
  • Dietitian, a specialist in nutrition and diet

There's no cure for EoE. But treatment can help you manage the inflammation that causes your symptoms. The main ways to do that are with diet changes and medication. It might take some trial and error, and you may need more than one treatment.

The first step is often trying an elimination diet. A food diary can help too as you keep track of what you eat and drink. For the elimination diet, you cut out certain food or drinks for several weeks to see how this makes you feel. If you do feel better, you gradually start adding one food or drink at a time back into your diet and see if the symptoms come back. It can be hard to figure out exactly which foods trigger flare-ups though because the response to the trigger doesn’t usually happen right away. You might eat a particular food for weeks or months before it starts to cause a problem. 

Talk to your doctor about the best way to track the foods that could be triggering your EoE flare-ups. If you do feel different with an elimination diet, your doctor may want you to have  another endoscopy to see how your esophagus looks after the diet changes.

If you find the foods that seem to make your symptoms worse, avoiding them might be all you need to do. If not, you might need medications, as well.

Medications for eosinophilic esophagitis

Proton pump inhibitors (PPIs). They reduce stomach acid. PPIs sometimes help with reflux symptoms but are not especially helpful for many people with EoE. If you do feel better with a PPI, your doctor will likely want to do an endoscopy to see if there are changes.

Corticosteroids. Steroid drugs, like budesonide or fluticasone, help control inflammation. You take oral budesonide (Eohilia) as a liquid by mouth. Fluticasone comes in an inhaler, but you swallow the mist rather than inhale it when you take it for EoE. If you don’t feel better with these, your doctor might prescribe prednisone, which is a steroid in pill form. Budesonide and fluticasone tend to cause fewer side effects than steroids you take as pills, which is why they’re tried first.

Monoclonal antibodies. Dupilumab (Dupixent), a monoclonal antibody drug, can help, but it’s only approved for anyone older than 1 year and weighing at least 33 pounds. The drug aims to ease inflammation and help you swallow. It’s given by injection, just under the skin, and works by blocking substances in your body that are involved in causing inflammation.

Other procedures for eosinophilic esophagitis

Endoscopy. If you have impacted food -- food that is blocking your esophagus -- your doctor will need to do an endoscopy and use the scope to remove the food. 

Esophageal dilation. If your esophagus is narrowed, it might become too hard to swallow. This could also lead to having impacted food. Esophageal dilation helps reopen the passageway. For this procedure, the doctor inserts an endoscope and threads a balloon down to your esophagus. The balloon is inflated to slowly stretch the esophageal wall. It’s then removed.

Home remedies for eosinophilic esophagitis

You can’t cure EoE with natural or alternative treatments, but you might be able to lessen your symptoms with some lifestyle changes.

  • Lose weight if needed or maintain your healthy weight. If you have extra fat in your belly area, this can put pressure on your stomach and cause your stomach acid to push up into your esophagus. 

  • Identify and avoid the foods and beverages that seem to trigger your symptoms.

  • Sleep with your head higher than the rest of your body. This doesn’t mean using extra pillows though, as this only lifts your head. Your upper body needs to be elevated to keep acid from backing up from your stomach.  You can put blocks under the feet at the top of your bed, so the whole thing is at an angle. You can also purchase special wedges that will help your upper body stay elevated.

Common foods that can trigger a worsening of EoE symptoms include milk, eggs, soy, dairy, seafood, and wheat. Doctors sometimes call this increase in symptoms a “flare-up.”

But it can be hard to figure out exactly which foods trigger flare-ups in your case. That’s because the response to the trigger doesn’t usually happen right away. You might eat a particular food for weeks or months before it starts to cause a problem.

A food diary can help, along with an elimination diet. Talk to your doctor about the best way to track the foods that could be triggering your EoE flare-ups.

 

Scarring. Doctors don’t yet understand all the long-term complications of EoE. They do know that in some people, EoE can start to scar the esophagus. This could narrow the esophagus. This could cause serious issues like choking and food impaction.

Tears in the esophageal wall. The inflammation of the esophagus raises the chance that you could tear the tissue that lines the esophagus. This could happen when you vomit or even when your doctor examines your esophagus with an endoscope. 

 If you notice a serious flare-up of your EoE, call your doctor. Symptoms that require medical attention include:

  • Increased problems swallowing
  • Increased, unintentional weight loss
  • Increased vomiting
  • Stomach pain

Call 911 if you have:

  • Pain in your chest
  • Food stuck in your throat
  • A hard time talking or breathing

 

One of the first changes you’ll have to make if you’re diagnosed with EoE is your diet. Identifying the foods and drinks that make your symptoms worse and then avoiding them might be challenging but worth it in the long run. Working with a dietitian or nutritionist can help you find alternatives to favorite foods and recipes and to come up with a food plan you can follow. 

Environmental allergies, like hay fever, might also affect you, so you’ll have to avoid those as much as possible as well. Once you know what triggers your symptoms, it’s important to educate the people around you, especially if they might prepare food for you. 

If your doctor prescribes medication, it’s essential to take it as prescribed. If you have problems with side effects or you are having difficulty getting the medications, speak with your doctor to see what options are available to you.

Some people with EoE have had frightening experiences when they tried to swallow and couldn’t. This type of thing can cause eating to be something to be scared of – a fear of swallowing. If you find yourself experiencing any kind of fear or worry related to having EoE, it might be helpful to speak with a mental health specialist.

Living with a chronic illness can be challenging. If you find yourself needing support as  you learn about your disease and how to live with it, you can reach out to others who know what you’re going through. There is a national organization called the American Partnership for Eosinophilic Disorders (APFED). Their website offers a section where you can look for support online and locally.

Eosinophilic esophagitis is a chronic, long-term condition that has no cure. You can manage the symptoms, but the disease itself won’t go away. The good news is that EoE doesn’t increase your risk of esophageal cancer, a worry that some people have.

EoE can’t be prevented, but if you recognize symptoms early, especially if you have a family history of the condition, you can take steps to keep it from worsening.

Eosinophilic esophagitis, or EoE, is a chronic, long-term condition that affects your esophagus. It can become hard or painful to swallow. Many times, EoE is caused by food allergies or even environmental ones, like hay fever. It’s important to get the right diagnosis because EoE symptoms are close to another condition called gastrointestinal reflux disease, or GERD. Treatment may be simply avoiding foods you’re allergic to, although many people with EoE do have to take medications as well.

Is eosinophilic esophagitis the same thing as GERD?

Eosinophilic esophagitis isn’t the same thing as GERD – gastroesophageal reflux disease – but they can share some of the same symptoms. GERD is caused by stomach acid that backs up into your throat, your esophagus. EoE is caused by having too many white blood cells, called eosinophils, in your esophageal wall and these cause inflammation.

Is eosinophilic esophagitis contagious?

EoE isn’t contagious. It’s an immune or allergy-related condition. 

Is eosinophilic esophagitis curable?

Eosinophilic esophagitis is a long-term, chronic disease. It can’t be cured. But treatments can help you reduce or, for some people, eliminate the symptoms, so you can continue living your normal life.

Can eosinophilic esophagitis cause throat cancer?

No, there is no evidence that having eosinophilic esophagitis raises your risk of having esophageal or throat cancer.