Eosinophilic esophagitis is a chronic inflammatory condition of the
esophagus that was unknown before the early 1990s. The disorder is
believed to be caused by an immune system reaction—most likely triggered
by a food allergy. Men are much more likely to be affected than women.
Symptoms vary with age. Adults usually have problems swallowing solid
foods, which may result in food lodging at the bottom of the esophagus
(food impaction). Research shows that up to one third of adults with
eosinophilic esophagitis experience food impaction that requires an
urgent endoscopic procedure. Other symptoms may include heartburn, chest
pain, or upper abdominal pain.
There is not yet a clear path to diagnosing eosinophilic esophagitis,
but a panel of international experts has recommended the following
Characteristic esophageal symptoms. In adults,
the most prominent symptoms are difficulty swallowing and food
Characteristic abnormalities on endoscopy. In a
person with typical esophageal symptoms, upper
endoscopy should be performed to look for abnormalities
associated with active inflammation and to collect a biopsy
specimen. The presence of eosinophils (inflammatory cells)
strongly suggests the diagnosis.
Absence of other causes. To make the diagnosis, it is
important to be sure that GERD or other conditions that can cause
similar symptoms and biopsy findings are not the culprit.
Because the underlying cause of eosinophilic esophagitis is unclear, no
definitive treatment has been defined. However, treatment strategies
have been suggested to help relieve symptoms, reduce the risk for
impaction, and prevent damage to the esophagus from chronic
Medications. The first-line drug therapy is
topical corticosteroids (medication is sprayed into the mouth
and then swallowed), which have been shown to be effective in
resolving symptoms and signs during flares of the disease.
Corticosteroids need to be used daily to remain effective.
Elimination diets. Another strategy is to
eliminate foods commonly associated with food
allergy—specifically, cow’s milk, soy, eggs, wheat,
peanuts/walnuts, and shellfish/fish. Research shows that
elimination diets can lead to remission (no symptoms and no
signs of inflammation on biopsy). In studies, wheat and cow’s
milk were the most common triggers in adults, followed by soy,
nuts, and eggs.
Esophageal dilation. If drugs and diet do not
control symptoms, another option is esophageal dilation. This
procedure is performed during upper endoscopy. While it will not
treat underlying inflammation, dilation can improve symptoms.
For more information, call 1.866.CALL.MLH.