What Is Eosinophilic Esophagitis (EoE)? Symptoms, Causes, Diagnosis, and Treatment

Eosinophilic esophagitis (EoE) is a rare disorder that can cause severe inflammation of the esophagus, or swallowing tube that connects the mouth to the stomach. In most cases, people with EoE experience difficulty swallowing certain foods, an uncomfortable feeling of having something stuck in their throat or chest, and problems with regurgitation and reflux of food into the esophagus, or heartburn symptoms. This article takes an in-depth look at what EoE is, how it’s diagnosed and treated, and its possible complications.

The Basics About Eosinophilic Esophagitis

If you’ve never heard of eosinophilic esophagitis (EoE), you’re not alone. While its name sounds like a rare affliction from a sci-fi novel, it’s actually an increasingly recognized allergic disease that affects at least two million Americans. Of those two million people with EoE, many of them don’t even know they have it. If left untreated or diagnosed too late in life, food allergies can lead to potentially fatal reactions called anaphylaxis; however in milder cases symptoms include heartburn and chronic acid reflux. Despite its prevalence among food allergy sufferers as well as average folks like you and me, awareness is still quite low. That’s why we’re here today—to shed some light on what EoE is, how it manifests itself physically, and how to treat it.

Common Signs and Symptoms of Eosinophilic Esophagitis

Different people can experience EoE in different ways. Some of these symptoms are more common than others. If you have symptoms of EoE, but they’re not that severe or frequent, you may not need to talk to a doctor right away. But if your signs and symptoms continue to get worse over time — or happen more frequently — it’s important to see a doctor for an official diagnosis as soon as possible. Here are some of the most common signs and symptoms of EoE 

1. Difficulty swallowing 

2. Chest pain 

3. Heartburn 

4. Food getting stuck 

5. Painful swallowing 

6. Frequent vomiting 

7. Weight loss 

8. Bad breath 

9. A feeling like food is stuck in your throat 

10. Coughing after eating 

11. Hoarseness 

12. Chronic sore throat 

13. Belching 

14. Gurgling sounds 

15. Abdominal pain 

16. Nausea 

17. Diarrhea 

18. Vomiting

 19. Constipation 

20. Feeling full quickly 

21. Stomach pain 

22. Loss of appetite 

The Different Types of Eosinophilic Esophagitis

There are three different types of eosinophilic esophagitis. All are based on how much inflammation is present in a person’s esophagus, but they have varying causes. The three different types of eosinophilic esophagitis include: EoE without allergy: This occurs when an individual is not allergic to anything specific yet still has signs of eosinophilic esophagitis. 

Food allergies are not present in these cases either. This form makes up about 20 percent of all cases of eosinophilic esofagus. The most common symptoms for patients with EoE that isn’t caused by food or environmental allergies are abdominal pain, heartburn, nausea, vomiting and dysphagia (difficulty swallowing). Gastroesophageal reflux disease can also be present. Patients who have non-allergic eosinophilic esophagitis tend to experience more chronic issues than those with other forms of eosinophilic esophagitis. Most people with non-allergic eosinophilic esophagitis will respond well to treatment with corticosteroids and proton pump inhibitors.

How is Eosinophilic Esophagitis Diagnosed?

It’s very important to seek medical treatment right away if you have any symptoms of eosinophilic esophagitis. An endoscopy will likely be ordered to determine if your symptoms are due to eosinophilic esophagitis or another condition. An endoscopy is a procedure in which a tiny camera called an endoscope is placed down your throat. Images from the endoscope can help provide insight into what’s causing your symptoms. 

You may also have blood tests run as part of your diagnosis. The two most common blood tests used to diagnose eosinophilic esophagitis are: Eosinophil count: This test measures how many white blood cells called eosinophils are present in your bloodstream. High levels of these cells indicate that you might have eosinophilic esophagitis. Eosinophil major basic protein (MBP) test: This test checks for elevated levels of an enzyme produced by white blood cells called eosinophils. Elevated levels indicate that there could be inflammation occurring within your digestive tract, which could mean that you have an allergic reaction or some other inflammatory condition like food allergy or celiac disease.

Alternative Treatments for Eosinophilic Esophagitis

In addition to medications, there are several alternative treatments for EoE. One of these is called esophageal dilatation. In short, during esophageal dilatation surgery a narrow tube-like device is inserted into your esophagus that gradually expands it over time. Some patients find it helpful to have their tubes removed after about a year. The downsides include lack of insurance coverage for most patients as well as a slightly higher risk of complications compared to anti-reflux surgery options. However, some people with severe cases of EoE may not be candidates for surgery.  Talk to your doctor if you’re interested in learning more about esophageal dilatation.

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Conclusion & Takeaways

Discovering that you or your child has EoE can be distressing. However, since it is a completely treatable disease with a strong response to treatment, learning as much as possible about it will help alleviate your fears. You’ll have questions at every step along the way — that’s normal! All of them are valid and important to ask your doctor. You’ll have to make changes in diet to see positive results but stick with it! It may take some time before you notice a difference but do not stop; keep trying different strategies until you find something that works for you!