Understanding Eosinophilic Esophagitis (EoE)

Is food getting stuck when you swallow? Do you need extra water to help meals go down? These symptoms may be more than reflux. They can be signs of eosinophilic esophagitis, or EoE.

What Is EoE?

Eosinophilic esophagitis is a chronic inflammatory condition of the esophagus, the tube that carries food from the mouth to the stomach. In EoE, a type of white blood cell called an eosinophil builds up in the lining of the esophagus. This inflammation can make the esophagus swollen, narrowed, or stiff over time.

EoE is often linked with allergic conditions, including asthma, eczema, seasonal allergies, or food allergies. It can affect both children and adults and is increasingly recognized as an important cause of swallowing problems.

Symptoms to Watch For

Symptoms vary by age and from person to person. Common signs in adults include:

• Difficulty swallowing, especially solid foods
• Food feeling stuck in the chest or throat
• Episodes of food impaction, when food becomes lodged and may require urgent endoscopic removal
• Chest discomfort or heartburn that does not improve as expected with reflux treatment
• Avoiding certain foods, chewing excessively, or drinking large amounts of liquid with meals

In children, symptoms can include feeding difficulties, vomiting, abdominal pain, poor appetite, or problems with growth.

Food stuck in the esophagus that does not pass is an emergency and requires immediate medical attention.

How Is EoE Diagnosed?

EoE cannot be diagnosed by symptoms alone. Evaluation typically includes an upper endoscopy, in which a thin, flexible camera examines the esophagus while the patient is sedated.

During endoscopy, the gastroenterologist may see signs of EoE, such as rings, furrows, white spots, swelling, or narrowing. However, the esophagus can sometimes look normal. For this reason, small tissue samples called biopsies are taken from different areas of the esophagus and examined under a microscope.

Treatment: A Personalized Approach

EoE is treatable. The goal is to control inflammation, improve swallowing, and prevent long-term scarring or narrowing of the esophagus. Treatment is individualized and may include one or more of the following:

Acid-suppressing medication (PPIs): Proton pump inhibitors, or PPIs, can reduce inflammation in some patients and may also treat coexisting acid reflux.

Swallowed topical steroids: These medications coat the esophagus to reduce inflammation. They are swallowed rather than inhaled into the lungs.

Dietary therapy: Certain foods can trigger EoE inflammation. Some patients benefit from an elimination diet that removes selected foods and then reintroduces them carefully. A registered dietitian can help make this approach safe, practical, and nutritionally balanced.

Esophageal dilation: If EoE has caused significant narrowing or a stricture, endoscopic dilation can gently widen the esophagus and improve swallowing. Dilation treats narrowing but does not replace anti-inflammatory treatment.

Biologic therapy: Dupilumab is a newer targeted biologic treatment that may be an option for selected patients, particularly when EoE remains active despite other treatment approaches or when allergic conditions are also present.

Why Follow-Up Matters

Feeling better is important, but symptoms do not always reflect the amount of inflammation in the esophagus. Follow-up visits and, when appropriate, repeat endoscopy with biopsies help confirm that treatment is working and guide long-term care.

When to See a Gastroenterologist

Schedule an evaluation if you have ongoing trouble swallowing, repeated episodes of food sticking, unexplained chest discomfort with eating, or reflux symptoms that do not improve as expected. Early diagnosis and treatment can help protect the esophagus and make eating more comfortable.

Gastro in Florida and Wellington Digestive Institute provide individualized evaluation and treatment for EoE and other swallowing disorders. Contact our office to schedule a consultation.

Call Gastro in Florida at (863) 824-3447 (Okeechobee) or (561) 767-8342 (Wellington), or book a televisit.

---