Eosinophilic Esophagitis: Symptoms, Causes, and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is eosinophilic esophagitis?
Eosinophilic esophagitis is a chronic immune condition in which eosinophils accumulate in the lining of the esophagus and cause inflammation, often as an allergic-type reaction to foods. Adults may have trouble swallowing and food getting stuck, while children may have feeding difficulty and vomiting. Most people need ongoing treatment, such as removing trigger foods or swallowed steroids. [1] [2]
What the research says
According to PubMed:
Dupilumab restored the esophageal lining in most patients. In a phase 3 trial of patients aged 12 and older, histologic remission at week 24 occurred in 60% (25 of 42) on weekly dupilumab versus 5% (2 of 39) on placebo in Part A (difference 55 percentage points; 95% CI 40-71), and in 59% (47 of 80) versus 6% (5 of 79) in Part B (Dellon et al., N Engl J Med, 2022; DOI).
Diet therapy works, and stricter diets work better. A meta-analysis of 43 studies with 2,825 patients found an overall histologic remission rate of 60.6%: 94.5% with elemental diets, 63.9% with six-food elimination diets, 54.7% with four-food, and 39.5% with allergy-test-directed diets (Arias et al., Nutrients, 2024; DOI).
Most drug options beat placebo, but there is no clear winner. A network meta-analysis of 15 randomized trials with 1,813 patients supported the efficacy of most available drugs, including proton pump inhibitors, topical steroids, and biologics, over placebo, but differences in trial design prevented a firm ranking (Visaggi et al., Gut, 2023; DOI).
Study details are from PubMed abstracts.
What eosinophilic esophagitis is
Eosinophilic esophagitis (EoE, pronounced e-o-sin-o-FILL-ik uh-sof-uh-JIE-tis) is a chronic immune system disease. Eosinophils are a normal type of white blood cell found in the digestive tract. In EoE, they build up in large numbers in the lining of the esophagus, the long, flexible tube that connects the mouth to the stomach. [1]
This buildup is a reaction to foods, allergens, or acid reflux, and it can inflame or injure the esophageal tissue. When the tissue is damaged, swallowing becomes difficult or food gets stuck partway down. The word esophagitis simply means swelling and irritation of the tissues that line the esophagus. Diagnoses have risen over the past decade, and the rise is thought to parallel increases in asthma and allergies. [1]
Symptoms: what it looks like in adults and children
The symptoms differ somewhat between adults and children, which is why the same disease can look very different depending on who has it. [1]
Symptoms in adults
Symptom | What it looks like |
Difficulty swallowing (dysphagia) | Food seems to move down the esophagus slowly or with effort |
Food impaction | Food gets stuck in the esophagus after swallowing |
Chest pain | Often felt in the center of the chest; does not respond to antacids |
Regurgitation | Undigested food comes back up |
Symptoms in children
Symptom | What it looks like |
Difficulty feeding (infants) or eating (children) | Meals become a struggle; feeding may be avoided |
Vomiting | Episodes may be frequent |
Abdominal pain | Stomach pain during or after meals |
Failure to thrive | Poor growth, malnutrition, and weight loss |
Dysphagia and impaction | Trouble swallowing; food gets stuck, same as in adults |
No response to reflux medicine | Heartburn symptoms persist despite standard GERD treatment |
When to see a doctor
Seek immediate medical attention for chest pain, especially when it is accompanied by shortness of breath or jaw or arm pain, because these may be signs of a heart attack rather than an esophageal problem.
Make an appointment with a healthcare provider if swallowing symptoms are severe or frequent. As a general rule, if you are taking nonprescription heartburn medicines more than twice a week, it is time to be evaluated.
Causes: how the allergic reaction unfolds
Eosinophils are a normal part of the digestive tract's immune defenses. In EoE, however, the lining of the esophagus mounts an allergic reaction to an outside substance, and a chain of events follows. [1]
Step | What happens |
1. Reaction of the esophagus | The esophageal lining reacts to allergens, such as food or pollen |
2. Multiplication of eosinophils | Eosinophils multiply in the esophagus and release a protein that causes inflammation |
3. Damage to the esophagus | Inflammation leads to scarring, narrowing, and excess fibrous tissue in the lining |
4. Dysphagia and impaction | Swallowing becomes difficult or food gets stuck |
Risk factors
Not everyone with allergies develops EoE, and not everyone with EoE has known allergies, but certain factors raise the odds of diagnosis. [1]
Risk factor | Detail |
Climate | More diagnoses occur in cold or dry climates than in others |
Season | Spring through fall brings more diagnoses, probably because pollen and other allergen levels are higher |
Sex | EoE is more common in males than females |
Family history | The condition sometimes runs in families, suggesting a genetic component |
Allergies and asthma | Food or environmental allergies, asthma, atopic dermatitis, or a chronic respiratory disease all raise the likelihood |
Age | Once thought to be a childhood disease, EoE is now known to be common in adults as well |
Complications
Untreated inflammation has consequences. Scarring and narrowing of the esophagus make swallowing harder and make food more likely to get stuck. And because the esophageal tissue is inflamed, even a routine endoscopy can cause perforation or tears in the lining; tearing can also occur with retching when food becomes stuck. [1]
How eosinophilic esophagitis is diagnosed
A provider weighs symptoms and test results together and also works to determine whether gastroesophageal reflux disease (GERD) is the true culprit. Several tools can be used. [2]
Upper endoscopy
The provider passes a long, narrow, flexible tube (endoscope) with a light and tiny camera through the mouth and down the esophagus. The lining is inspected for inflammation and swelling, horizontal rings, vertical furrows, narrowing (strictures), and white spots. Some people with EoE have an esophagus that looks entirely typical on endoscopy, which is why tissue sampling matters. [2]
Biopsy
During the endoscopy, multiple small tissue samples are taken from the esophagus and examined under a microscope for eosinophils. This step usually confirms the diagnosis. [2]
Blood tests
Additional tests may look for the sources of the allergic reaction. Higher-than-usual eosinophil counts or elevated total immunoglobulin E (IgE) levels suggest an allergy. [2]
Esophageal sponge
This office-based test avoids an endoscopy. The patient swallows a capsule attached to a string; the capsule dissolves in the stomach and releases a sponge. The provider pulls the string to draw the sponge back up through the mouth, sampling the esophageal tissue along the way. The samples show how much inflammation is present. [2]
Treatment options
EoE is a chronic, relapsing disease, which means most people need ongoing treatment to keep symptoms under control. Care usually involves one or more of the following approaches. [2]
Dietary therapy
Depending on food allergy test results, the provider may recommend stopping certain foods. Cutting out some foods, dairy or wheat products for example, can relieve symptoms and reduce inflammation. Sometimes the diet is limited even further. [2]
Medication
Medicine | How it works | Key points |
Proton pump inhibitor (PPI) | Acid blocker, usually tried first | Easiest to use, but most people's symptoms do not improve |
Topical steroid (fluticasone or budesonide) | A swallowed liquid steroid that treats the esophagus directly | Not absorbed into the bloodstream, so typical steroid side effects are less likely |
Monoclonal antibody (dupilumab) | Blocks the proteins that cause inflammation; given weekly by injection | FDA-approved for adults and children 1 year and older who weigh at least 33 pounds (15 kg) |
Dilation
If the esophagus has become severely narrowed (a stricture), dilation, or stretching, can make swallowing easier. It may be used when steroids have not helped, or chosen to avoid ongoing medication. [2]
Self-care at home
General reflux-style habits can reduce the frequency or severity of heartburn-type symptoms. Maintain a healthy weight, losing weight gradually if needed, avoid foods and drinks that commonly trigger heartburn such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine, and consider raising the head of the bed 6 to 9 inches with blocks under the bed feet or a wedge. These steps do not treat EoE itself, so keep following the plan your provider recommends.
Preparing for your appointment
Care usually starts with a regular healthcare provider, who may refer you to a gastroenterologist (a digestive disease specialist) or an allergist. Bring any prior test results, write down all symptoms (including ones that seem unrelated), list every medication, vitamin, and supplement, and consider bringing a family member or friend. Useful questions to ask include whether the condition is temporary or chronic, which tests are needed, whether an endoscopy is required, and what the alternatives to the primary treatment plan are.
Conclusion
Eosinophilic esophagitis is a treatable condition, but it is chronic and the inflammation tends to return when treatment stops. The most important moves are getting a proper diagnosis (endoscopy with biopsy), identifying trigger foods, and sticking with the treatment plan a provider recommends. With ongoing care, most people keep swallowing comfortably and avoid the complications of a narrowed esophagus. [1] [2]
Next steps: If food gets stuck when swallowing, meals are regularly difficult, or reflux medicines have stopped working, make an appointment with a healthcare provider. Never ignore chest pain with shortness of breath or jaw or arm pain.
Frequently asked questions
What is the difference between eosinophilic esophagitis and GERD?
Both can cause heartburn-like symptoms, but EoE is an allergic immune reaction with white blood cell buildup in the esophageal lining, while GERD is caused by stomach acid washing back up. A key clue is when reflux symptoms do not respond to reflux medication. [1]
Is eosinophilic esophagitis curable?
EoE is considered a chronic, relapsing disease. Most people need ongoing treatment, such as dietary changes, medication, or both, to keep symptoms controlled, and symptoms commonly return when treatment stops. [2]
What foods trigger eosinophilic esophagitis?
Reactions are individual, but dairy and wheat are common culprits. Depending on food allergy test results, a provider may recommend removing certain foods or limiting the diet more broadly. [2]
Can eosinophilic esophagitis cause food to get stuck?
Yes. Food getting stuck in the esophagus after swallowing is one of the hallmark symptoms, especially in adults, and repeated inflammation can scar and narrow the esophagus, making it more likely. [1]
Is eosinophilic esophagitis hereditary?
The condition sometimes runs in families, which suggests a genetic component. It is also more common in people with food or environmental allergies, asthma, atopic dermatitis, or other chronic respiratory disease. [1]
This article is for general education and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about your individual situation.
How is eosinophilic esophagitis diagnosed?
The main test is an upper endoscopy, where a thin camera looks at the esophagus and small tissue samples are taken. The samples are checked under a microscope for eosinophils. Some clinics also use a swallowed sponge test that avoids a full endoscopy.
What medicines treat eosinophilic esophagitis?
Common options include acid-blocking pills called proton pump inhibitors, swallowed steroids that coat the esophagus, and dupilumab, an injection that calms the inflammation. Your provider will choose based on your age, symptoms and test results.
What should I do if food gets stuck in my throat?
Go to the emergency room right away if food is stuck and you cannot swallow your own saliva, are drooling, or have trouble breathing. Do not try to force it down with more food. A doctor can safely remove it.
What is an elimination diet for EoE?
An elimination diet removes common trigger foods, such as dairy or wheat, for a period of time. Foods are then added back one at a time while your provider checks whether the inflammation returns, often with a repeat endoscopy. Work with your care team or a dietitian so you still get enough nutrition.
Can children get eosinophilic esophagitis?
Yes. In children it may cause feeding problems, vomiting, belly pain or poor growth rather than food getting stuck. Reflux symptoms that do not improve with reflux medicine are another clue. Talk to your child's doctor if you notice these signs.
Related Reading
Elemental Diet: What It Is, Uses and How It Works explains the elemental diet.
EndoFLIP Test: Measuring Your Esophagus for Swallowing Problems explains the balloon test that measures how well the esophagus opens.
Learn more in our guide to Esophageal Dilation: Uses, Procedure, Risks and Recovery.
Esophagoscopy: Why It's Done, Types, What to Expect, Results and Risks explains the scope procedure used to look inside the esophagus, take samples and remove stuck objects.
References
Mayo Clinic Staff. Eosinophilic esophagitis: Symptoms and causes. Mayo Clinic. Accessed October 14, 2026. https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/symptoms-causes/syc-20372197
Mayo Clinic Staff. Eosinophilic esophagitis: Diagnosis and treatment. Mayo Clinic. Accessed October 14, 2026. https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/diagnosis-treatment/drc-20372203
Dellon ES, Rothenberg ME, Collins MH, et al. Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med. 2022;387(25):2317-2330. PMID 36546624. https://doi.org/10.1056/NEJMoa2205982
Arias Á, Tejera-Muñoz A, Gutiérrez-Ramírez L, Molina-Infante J, Lucendo AJ. Efficacy of Dietary Therapy for Eosinophilic Esophagitis in Children and Adults: An Updated Systematic Review and Meta-Analysis. Nutrients. 2024;16(14). PMID 39064673. https://doi.org/10.3390/nu16142231
Visaggi P, Barberio B, Del Corso G, et al. Comparison of drugs for active eosinophilic oesophagitis: systematic review and network meta-analysis. Gut. 2023;72(11):2019-2030. PMID 37491157. https://doi.org/10.1136/gutjnl-2023-329873
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