Eosinophilic esophagitis, or EoE, is inflammation of the esophagus (swallowing tube) that is related to allergies. Eosinophils are a type of white blood cell that is involved in allergic reactions. Normally, the esophagus has almost none present. For people with EoE, these white blood cells build up in the esophagus, resulting in inflammation. While the cause of EoE is not very well understood, the general belief is that it’s likely due to sensitivity to specific foods or possibly allergens in the air that are swallowed. At the University of Michigan’s Esophageal Disorders Program, our dedicated, multidisciplinary team has broad experience diagnosing and treating eosinophilic esophagitis, with cutting-edge diagnostic testing, therapies that are not available widely, and a dedicated nutritionist with expertise in eliminating trigger foods.
Eosinophilic Esophagitis Symptoms
It’s most common for EoE to present in childhood or early adulthood, but it can show itself at any age. In some people, symptoms can be very intermittent, such as trouble swallowing once every few months. Many people have had symptoms for years before a diagnosis is made. In adults, typical symptoms include:
- Trouble swallowing solid foods (also called dysphagia), including food impactions, which involves food getting stuck in the esophagus, requiring vomiting for it to come out. Sometimes the food cannot be vomited either, which requires a doctor to remove the food using a thin scope.
- Chest discomfort
- Globus—the sensation of having a lump in the throat
- Itchy throat when eating
Diagnosing Eosinophilic Esophagitis
To diagnose EoE, we begin with a thorough conversation to understand your symptoms, and a physical examination. Based on your risk factors, your doctor might recommend an upper endoscopy: Upper endoscopy, also known as an esophagogastroduodenoscopy or EGD, uses an endoscope—a lighted, flexible tube, about the thickness of a finger—to examine the upper gastrointestinal tract, consisting of the esophagus, stomach and duodenum (the first part of the small intestine). A special instrument may be passed through the tube to take a small piece of tissue (a biopsy) for examination in the laboratory. We prefer to conduct an EGD with biopsy while patients are taking a proton pump inhibitor, or PPI, which is used to reduce acid in those with gastroesophageal reflux disease (GERD). Typical GERD can sometimes cause eosinophilic inflammation in the esophagus, however this is not “EoE.” Using the proton pump inhibitor will help us to make a more precise diagnosis. Once EoE is confirmed, allergy testing might be conducted to identify “trigger foods” that are causing inflammation in the esophagus. Interpretation of allergy tests requires specific expertise. In addition to standard skin-prick testing for allergies (scratching foods or allergens into the skin and then looking for reactions), our allergists also perform atopy patch testing (foods are placed in tiny cups that are attached to the patient’s back for 48 hours), which provides useful information for those with delayed food reactions.
Treating Eosinophilic Esophagitis
The goal of treatment is to eliminate the eosinophils from the esophagus and to reduce symptoms. Standard treatments include: Topical steroids: The medication coats the lining of the esophagus, with very little if any getting absorped and circulated to the rest of the body. Topical steroids can help decrease the number of white blood cells in the esophagus. Allergy testing followed by elimination of specific foods: Eliminating foods that a patient is potentially allergic to, based on the results of the allergy tests. Once symptoms have resolved, the eliminated foods are added back into the diet—one or two at a time—and the patient is observed for any reaction to the newly introduced foods and undergoes repeated endoscopies with biopsies to confirm the effect on the esophagus. Removal of most common allergen foods: The most common foods causing eosinophilic esophagitis can be removed from the diet (dairy, wheat, soy, and egg). Once symptoms have resolved, the eliminated foods are added back into the diet—one at a time—and the patient is observed for any reaction to the newly introduced foods. Endoscopic dilation of strictures: Narrowings of the esophagus, called strictures, are dilated (widened) with an endoscope using balloons or tapered tubes. The widening allows food to pass more easily through the esophagus. Our multidisciplinary team includes experts in allergy, pathology, and radiology.
Research for Eosinophilic Esophagitis
Because our physicians are also conducting research, they are on the forefront of understanding eosinophilic esophagitis, with our experts involved in improving diagnostic testing for identifying EoE food triggers and in trials of new treatments for EoE. Patients who qualify can participate in clinical trials, allowing them access to the latest therapies available.
Other Information About Digestive and Liver Health
To see related medical services we offer, visit our Digestive and Liver Health overview page.
Make an Appointment
To schedule an appointment to discuss your need for treatment for EoE or any other esophageal condition, call us at 888-229-7408.