Eosinophilic Esophagitis: Symptoms, Diagnosis and Treatment

Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory disease of the esophagus (the tube connecting the mouth to the stomach). It occurs when a type of white blood cell, the eosinophil, builds up in the esophagus. The elevated number of eosinophils results in injury and inflammation to the esophagus which can make eating difficult or uncomfortable, potentially resulting in poor growth, chronic pain and difficulty swallowing.

Symptoms of EoE can vary by age and range from poor growth, vomiting and feeding refusal in infants and children to impactions (food getting stuck in the esophagus) in older children. When a narrow esophagus causes a food impaction, this is a medical emergency.

What We Know

EoE is no longer a rare disease. In the United States it EoE affects approximately 1 out of 700 children and adults of all ages and ethnic backgrounds. While both males and females may be affected, a higher incidence is seen in males. People with EoE often have other allergic conditions like rhinitis, asthma, food allergies triggered by immune reactions, and eczema. We do not know the exact cause of EoE, but we understand that it is an immune response to specific foods. A tendency to develop EoE may be inherited, and researchers have identified specific genes that contribute to the condition. These discoveries may provide new directions to diagnose, monitor and treat EoE in the future.

How EoE is Diagnosed

EoE is diagnosed by a gastroenterologist by taking a careful history and performing an upper endoscopy. With a traditional endoscopy, the patient is either sedated or put under anesthesia, and a small tube called an endoscope is inserted through the mouth.

During an endoscopy, the esophagus, stomach and first part of the small intestine are examined for tissue injury, inflammation and thickening of the esophageal wall. Small tissue samples are taken (biopsy). This procedure is typically not uncomfortable and may be done on an outpatient basis. A pathologist will analyze the tissue samples under a high-powered microscope to see the small cell structures. If eosinophils are present in the sample, the pathologist will count how many are visible. A count of 15 or more eosinophils per high-powered microscopic field is highly suggestive of EoE. A patient may have EoE even if the esophagus looks normal during the endoscopy. The biopsies will help in making an accurate diagnosis. Endoscopy with the biopsies is currently the only reliable method of diagnosing EoE.

How EoE is Treated

EoE treatment requires a multidisciplinary approach to shared decision-making to help your family make the right treatment choice for your child. This could involve managing diet by eliminating certain foods, or using medications like swallowed steroids, drugs that reduce stomach acid, or treatments made from living organisms. Sometimes, when the esophagus is too narrow, we’ll need to stretch or dilate it to help improve swallowing. At Nationwide Children’s, we work with a team of gastroenterologists, allergists, psychologists, dietitians, social workers, speech-language pathologists and care coordinators to provide the best plan for your child.

How EoE is Monitored

EoE is a chronic disease that requires ongoing monitoring and management. In addition to sedated endoscopies, there are now sedation-free methods available to see if your child’s EoE is responding to their treatment. One option is transnasal endoscopy where the endoscope is inserted through the nose while the patient is awake. Additionally, our center offers the esophageal string test, an innovative tool to assess EoE activity. Talk to your doctor about what is the best test for your child.