About EoE
Understanding EoE
If you're living with EoE, it can be a lot to manage. Here you can find out more about what causes EoE, its symptoms, and common triggers. Understanding more about your condition can help you feel more prepared to deal with its challenges.
What is EoE?
Eosinophilic esophagitis (EoE) is a chronic, progressive condition that causes inflammation in the esophagus. It affects people of all ages.1
- Chronic = lasts a long time, even a lifetime
- Progressive = gets worse over time
It's a long name to say, so let's break it down together:
Eosinophilic
ee - oh - sin - oh - fill - ic
This refers to a type of white blood cell found in your esophagus called an eosinophil.2,3
Esophagitis
eh - sof - uh - jye - tis
This means inflammation of your esophagus – the tube that connects your mouth to your stomach.2,3
How does EoE affect the esophagus?
The esophagus is the tube through which your food travels down from your mouth to your stomach.4
Although you can’t see anything on the outside of your throat,
EoE changes how the esophagus looks and feels on the inside.5
EoE can cause swelling, scarring, and narrowing of your esophagus. This can lead to EoE symptoms, such as difficulty swallowing or food getting stuck in your throat.3,6
EoE is a progressive disease which means that without treatment, it may get worse over time.6,7 As the esophagus becomes more swollen, scarred, and narrow, swallowing can become more painful, and there is increased risk of food getting stuck in the throat.8
Disease progression
Here's an outline of how EoE changes the esophagus if left untreated:
- Inflammation in your body causes the esophagus to swell, which causes thin red lines – or furrows – to develop
- High numbers of eosinophils – a type of white blood cell – clump together and form white spots on your esophagus called exudates
- Swelling of the lining of your esophagus causes circular rings to form
Even when you’re not having trouble swallowing, the inflammation may still be there. Over time, it could damage your esophagus and make your EoE symptoms even worse.
EoE is a long-term, inflammatory condition that affects the esophagus.6,7
It is important to ask your doctor whether an endoscopy should be performed to assess your esophagus.
Signs and symptoms of EoE
EoE affects different people in different ways, and not everyone will experience all of the symptoms.
Here are some common ones9:
Difficulty swallowing (dysphagia)
Food feeling stuck in your throat (impaction)
Heartburn
Chest pain
Coughing
Vomiting
People with EoE might find it difficult to swallow solid food. The foods often found the most challenging are meat, bread, and foods with rough textures.10,11
Children and teenagers with EoE often experience different symptoms to adults, such as stomach pain or vomiting.9,12 You can find out more in the EoE in children section.
Because of this, many people use workarounds to help make mealtimes easier. Adapting the way you eat can help you get the food down, but the problem with these habits is that they can easily become part of your daily routine. This could stop you from noticing that your symptoms are getting worse over time.
What causes EoE?
No one knows exactly why some people get EoE. It’s likely to be caused by a combination of different factors2,7,13,14:
Immune-related
Genetics
Your environment
EoE causes in detail:
Immune-related
The immune system is our body’s natural defence, but if you have EoE, yours is overactive.
Our immune system responds to threats like bacteria and viruses with inflammation to help protect the body.15,16 With EoE, the immune system also thinks that other substances, called allergens, are a threat too.13 These allergens could be certain foods or pollen, among others.
When you have EoE, even when this 'trigger' goes away, your body keeps trying to fight back, and inflammation may persist.
Genetics
EoE can run in the family but many people living with EoE may not have any family connection to the condition.14
Several genes have been linked with EoE, relating to the immune system or the structure of the esophagus lining.14 Although genes may play a role in EoE, it only makes you 15% more likely to get EoE.14,17,18
Your environment
When you live with EoE, airborne allergens like pollen or mold may worsen inflammation in your esophagus.19,20
The link between EoE and Type 2 inflammation
Type 2 inflammation is the way the immune system defends the body against certain external parasites. By contrast, Type 1 inflammation defends the body against infections.
EoE food triggers
EoE symptoms are most commonly caused by food allergens. However, it's important to remember that EoE is not a food allergy.9,20 With a food allergy, your symptoms – such as hives – usually happen straight away. With EoE, symptoms can be delayed for days.9,20 If you’re living with EoE, you may be following a diet that avoids certain food groups to help reduce your symptoms.19
Most common food triggers19:
Dairy
Nuts
Eggs
Wheat
Seafood
Soy
Some adults may have lived with EoE since childhood, while others may develop symptoms later in life.24 You may be more likely to be diagnosed with the condition if you are1:
Under 50 years of age
Male
Of white ethnicity
Conditions linked to EoE
The Type 2 inflammation that drives EoE is also linked with other conditions.24,25
That means that living with EoE makes you more likely to have other related conditions – called comorbidities – that are also driven by Type 2 inflammation.25
Approximately 75% of all people living with EoE develop other inflammatory conditions, such as:
Asthma
Atopic Dermatitis (eczema)
Allergic rhinitis (hay fever)
Environmental and/or food allergies
How is EoE treated?
If you've been diagnosed with EoE, discussing your treatment or management options can make a big difference. You can talk with your doctor to find the right care for you. This can include:
Food Elimination
It’s very common for EoE symptoms to be triggered by food allergens.20
Your doctor may suggest eliminating common ‘trigger’ foods from your diet to see if it helps improve symptoms. This is known as an elimination diet.20 Some patients can find this approach restrictive or difficult to maintain around their daily lives. It's worth discussing your lifestyle and preferences with your doctor to find a management plan that works best for you.
They may also recommend a nutritional diet involving only liquid food to improve your symptoms, also known as an elemental diet.20
Before making any changes to your diet, it’s important to check with your doctor too so they can ensure you’re getting all the nutrition you need.27
Proton pump inhibitors (PPIs)
PPIs are medications that are used to treat a range of gastrointestinal disorders. They reduce the amount of acid the stomach makes, and may help reduce inflammation, which can improve your EoE symptoms.28,29
Swallowed topical steroids
Topical steroids are a type of medicine that can help reduce inflammation in your esophagus and ease EoE symptoms. They come in three main forms: a slurry (a thick liquid you swallow), a powder taken using an inhaler, or a tablet that dissolves in the mouth. These treatments can be used for adults with EoE.30,31
Biologics
Biologics are medications designed to target specific parts of your immune system to reduce the inflammation that causes your EoE. The medicine is taken by injection under the skin (subcutaneous injection) and may be administered at different time intervals.
Biologics can help:
- Reduce the Type 2 inflammation that causes EoE
- Improve your symptoms
- Prevent EoE getting worse over time
- Reduce the need for food elimination or other medications
Your doctor can suggest the best biologic for you based on your symptoms.
Esophageal dilation
An esophageal dilation is a medical procedure that widens and gently stretches your esophagus to make swallowing easier. A doctor inserts a thin, flexible tube with a balloon attached into the esophagus and inflates the balloon to stretch the narrowed area.32
Your doctor will only recommend this procedure if your symptoms are severe and other management options have failed to help.33
References
- Dellon ES. Gastroenterol Clin North Am 2014; 43(2): 201–218.
- Underwood B et al. Ann Allergy Asthma Immunol 2023; 130: 28–39.
- Muir AB and Falk GW. JAMA 2021; 326(13): 1310–1318.
- Cambridge Dictionary. Oesophagus. Available at: https://dictionary.cambridge.org/dictionary/english/oesophagus Accessed October 2024.
- Hirano I and Aceves SS. Gastroenterol Clin North Am 2014; 43(2): 297–316.
- Lucendo AJ and Molina-Infante J. Curr Opin Gastroenterol 2018; 34(4): 226–232.
- Lucendo AJ et al. United Eur Gastroenterol J 2017; 5(3): 335–358.
- Schoepfer AM et al. Immunol Allergy Clin North Am. 2024; 44(2): 197–204.
- Gonsalves NP and Aceves SS. J Allergy Clin Immunol 2020; 145(1): 1–7.
- Carr S, Chan ES, Watson W. Allergy Asthma Clin Immunol 2018; 14(suppl 2): 58.
- Guts UK. Eosinophilic diseases. Available at: https://gut8arity.org.uk/advice-and-information/conditions/eosinophilic-diseases/ Accessed October 2024.
- Pokrzynwinski R et al. Adv Ther 2020; 37: 4458–4478.
- Muir AB, Wang JX, and Nakagawa H. J Gastroenterol 2019; 54(1): 10–18.
- Kottyan LC and Rothenberg ME. Mucosal Immunol 2017; 10(3): 580–588.
- Merriam-Webster. Immune system. Available at: https://www.merriam-webster.com/dictionary/immune%20system Accessed October 2024.
- Merriam-Webster. Inflammation. Available at: https://www.merriam-webster.com/dictionary/inflammation Accessed October 2024.
- Alexander ES et al. J Allergy Clin Immunol 2014; 134(5): 1084–1092.e1.
- Dellon ES and Hirano I. J Gastroenterol 2018; 154(2): 319–332.e2.
- Visaggi P et al. Nutrients 2021; 13(5): 1630.
- American Academy of Allergy Asthma & Immunology. Eosinophilic Esophagitis. Available at: https://www.aaaai.org/conditions-treatments/related-conditions/eosinophilic-esophagitis Accessed October 2024.
- Gonsalves NP. Dig Dis 2014; 32(1–2): 89–92.
- Muir AB et al. Clin Exp Gastroenterol 2019; 12: 391–399.
- Hahn JW et al. Clin Gastroenterol Hepatol 2023; 21: 3270–3284.
- Chehade M et al. J Allergy Clin Immunol Pract 2018; 6(5): 1534–1544.
- Van Rhijn BD and Bredenoord AJ. J Clin Gastroenterol 2017; 51(8): 659–668.
- American College of Allergy, Asthma & Immunology. Type 2 Inflammatory Disease. Available at: https://acaai.org/type-2-inflammatory-disease/ Accessed November 2024.
- Cianferoni A et al. Clin Exp Allergy 2019; 49(3): 269–284.
- Cleveland Clinic. Proton Pump Inhibitors. Available at: https://my.clevelandclinic.org/health/articles/proton-pump-inhibitors Accessed November 2024.
- Feo-Ortega S and Lucendo AJ. Ther Adv Gastroenter 2022; 15: 1–19.
- Nennstiel S and Schlag C. World J Gastroenterol 2020; 26(36): 5395–5407.
- Główczewski A and Krogulska A. J Clin Med 2022; 11(5): 1454.
- Cleveland Clinic. Esophageal Dilation. Available at: https://my.clevelandclinic.org/health/procedures/esophageal-dilation Accessed November 2024.
- Mayo Clinic. Eosinophilic esophagitis – Diagnosis & treatment. Available at: https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/diagnosis-treatment/drc-20372203 Accessed November 2024.