Eosinophilic esophagitis, usually shortened to EoE, is a condition that has become much more common and better understood in recent years. It is an allergic reaction in the esophagus that causes inflammation, and its most common sign is food getting stuck when you swallow. Many people live with it for years before it is diagnosed. Here is what EoE is, how to recognize it, and how it is treated.
What EoE Is
EoE happens when a type of white blood cell called an eosinophil builds up in the lining of the esophagus. These cells are part of the immune system and are linked to allergies. In EoE, they gather in the esophagus in response to certain foods or allergens, causing inflammation that over time can make the esophagus stiff and narrow.
Symptoms
Symptoms differ by age. In teens and adults, the most common are:
- Trouble swallowing, especially with dry or dense foods like bread and meat
- Food getting stuck in the esophagus, sometimes needing urgent care to remove
- Chest or upper belly discomfort
- Heartburn that does not respond to usual reflux treatment
Some people unknowingly adapt by eating slowly, chewing a lot, cutting food into tiny pieces, and always drinking water with meals. Those habits can be a clue. See our guide on trouble swallowing.
What Causes It
EoE is closely tied to allergies. Many people with it also have asthma, eczema, hay fever, or food allergies. Certain foods, most often dairy, wheat, eggs, soy, nuts, and seafood, are common triggers. It is not caused by something you did, and it tends to run in families with allergic conditions.
How It Is Diagnosed
EoE can only be confirmed with an upper endoscopy and biopsies. During the exam, I take small tissue samples from the esophagus and a lab counts the eosinophils. This matters because EoE looks a lot like acid reflux on the surface, and the biopsy is what tells them apart. We also often check for allergies.
Treatment
The goal is to reduce the inflammation, relieve symptoms, and prevent the esophagus from narrowing. The main approaches, often summarized as diet, drugs, and dilation, are:
- Diet: removing common trigger foods, then adding them back one at a time to find the culprits.
- Medication: proton pump inhibitors, or swallowed topical steroids that coat the esophagus and calm the inflammation. A newer injectable medication is also now available for some patients.
- Dilation: if the esophagus has narrowed, a gentle stretching during endoscopy can restore comfortable swallowing.
Living With EoE
EoE is a long-term condition, but it is very manageable. Most people do well once the right trigger foods or medication are found, and staying in follow-up helps keep the esophagus healthy and prevents food from getting stuck. If you have ongoing swallowing trouble or reflux that will not settle, ask about being checked for EoE.
Talk to a Gastroenterologist in Mountainside, NJ
If your symptoms keep coming back or you are not sure what is causing them, Dr. Amber Khan can help. We see patients from across Union County and New Jersey.