What kind of diet changes or restrictions are usually recommended to manage eosinophilic esophagitis?

Focus on elimination diets to identify food triggers. Common approaches include the "six-food elimination diet" (SFED), which removes milk, wheat, soy, egg, peanuts/tree nuts, and fish/shellfish, or a more targeted approach based on allergy testing. A registered dietitian can help guide this process to ensure nutritional adequacy.

How is eosinophilic esophagitis typically diagnosed, and what tests are involved?

Diagnosis primarily involves an upper endoscopy with biopsies of the esophagus. During the endoscopy, a doctor will look for signs of inflammation and take small tissue samples. These samples are then examined under a microscope to count the number of eosinophils present, which confirms the diagnosis if levels are elevated. Other tests might include allergy testing to identify potential triggers.

Is eosinophilic esophagitis a lifelong condition, and what are the long-term treatment goals?

EoE is generally considered a chronic condition, meaning it often requires ongoing management. While there isn't a "cure," treatments aim to control symptoms, reduce inflammation, and prevent complications like esophageal narrowing (strictures). Long-term goals include maintaining remission through diet modifications, medication (like swallowed topical steroids), or esophageal dilation if needed, to improve quality of life and prevent permanent damage.

Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic disease where white blood cells build up in the esophagus, causing inflammation and difficulty swallowing.

What is eosinophilic esophagitis (EoE)?

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain, trouble swallowing, and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, it is being diagnosed more often. Some people who think that they have reflux (GERD) may actually have EoE.

Causes & Risk Factors

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

EoE can affect anyone, but it is more common in people who:

Are male
Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
Have family members with EoE

Symptoms

The most common symptoms of EoE can depend on your age.

In infants and toddlers:

Feeding problems
Vomiting
Poor weight gain and growth
Reflux that does not get better with medicines

In older children:

Vomiting
Abdominal pain
Trouble swallowing, especially with solid foods
Reflux that does not get better with medicines
Poor appetite

In adults:

Trouble swallowing, especially with solid foods
Food getting stuck in the esophagus
Reflux that does not get better with medicines
Heartburn
Chest pain

Diagnosis

To find out if you have EoE, your doctor will likely:

Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

Treatment & Management

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines

Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.
Monoclonal antibodies, which can reduce inflammation and may help with swallowing. They can be used in adults and children over age 12.

Dietary Changes

Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
- With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
- For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.