Understanding EoE: Signs, Triggers, and Effective Treatments

Meet Anna, a patient with EoE. “Food had been becoming more difficult to swallow for months. I could feel it moving slowly down my esophagus, but if I ate small bites and drank extra water, I could get it to go down. I told myself I was fine. I was managing. I kept on ignoring the symptoms. Unfortunately, I was on vacation at the beach when a piece of shrimp got stuck. This led to a trip to the ER to have the shrimp removed from my throat. It was in that moment sitting in the ER, that I realized that I needed to take my EoE more seriously and that my refusal to see the symptoms had just ruined my vacation”.

Anna’s scenario is unfortunately all too common. Although many individuals feel like they are managing with some trouble swallowing, as the inflammation in the esophagus increases food can get stuck and has to be removed, often in an ER. But why did this happen? Lets explore EoE a little further.

What is Eosinophilic Esophagitis

EoE is a chronic immune mediated condition that affects the esophagus, the tube that connects the mouth to the stomach. EoE is characterized by a specific type of white blood cell, called an eosinophil, in the esophagus. Normally, there should not be any eosinophils in the esophagus. However, in EoE, the eosinophils start to cause inflammation of the esophagus and may even lead to narrowing or “strictures”, which is what makes it difficult to swallow and get food to pass.

In adults, the main symptoms include abdominal pain, chest pain when eating, heartburn, vomiting, difficulty swallowing, feeling like food is sticking in the esophagus or going down really slowly. Children, especially young children, often present differently with vomiting, fussiness during meals, refusing to eat and poor growth.

Diagnosis

EoE is officially diagnosed after a scope (EGD) is performed where a GI specialist uses a camera to go down the esophagus. During this procedure, biopsies are taken. These tiny pieces of tissue from the esophagus are sent to the lab and examined for eosinophils. If a sample has > 15 eosinophils p/hpf, a diagnosis of EoE is made.

Treatment

The basis of treatment for EoE is to remove the foods that are triggering the eosinophils to migrate to the esophagus. The most common triggers for EoE include dairy, wheat, eggs, and soy. It is often recommended that these foods be avoided for several months in order to help reduce the inflammation in the esophagus.

It is also common that medications are used in combination with the food elimination diet. The following medications are used to treat EoE:

• Proton Pump Inhibitors (PPI): Most individuals with EoE will be started on a proton pump inhibitor to control the acid in the stomach in hopes of reducing the inflammation in the esophagus. However, not every individual with EoE will see elimination of symptoms with a PPI alone. In many cases, additional medications are needed.

• Swallowed steroids. A limited course of steroids (up to 8 weeks) are often used to help reduce the inflammation in the esophagus. For years, swallowed budesonide prescribed in the nebulizer formulation has been mixed into a slurry and swallowed to coat the esophagus. However, newer formulation of steroids, such as Eohilia, are available where the steroid is already mixed into a thick liquid that is able to coat the esophagus when swallowed.

• Dupixent. The newest treatment for EoE, and arguably one of the most effective is Dupixent. Dupixent is a targeted biologic which works by inhibiting inflammatory pathways IL4 and IL13. This results in a reduction of eosinophils and inflammation in the esophagus.

Conclusion

If you or someone you know is struggling with symptoms such as difficulty swallowing, vomiting, or feeling like food is getting stuck, it is important to get checked for EoE. If you know you have EoE and are still having symptoms, it is important to find a provider who will listen and help you personalize your treatment plan for the best control of your EoE. At Monarch Medical, our nurse practitioners have years of experience treating EoE and are ready to help you make a plan so you can eat every meal with confidence and spend every minute of your vacation on the beach- not in the ER.

Additional Resources

American Academy Allergy, Asthma and Immunology (2026). https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/eosinophilic-esophagitis