Eosinophilic Esophagitis (EoE)

What is EoE?

Eosinophilic Esophagitis, often called EoE, is a condition where the esophagus (the food pipe that carries food from the mouth to the stomach) becomes inflamed. This inflammation is caused by a build-up of a certain type of white blood cell called an eosinophil.

EoE makes it harder for food to move down smoothly and can cause trouble swallowing, chest discomfort, or food getting “stuck.” In children, it may also show up as abdominal pain, nausea, vomiting, or refusal to eat certain foods.

Symptoms

The symptoms of EoE can look very different depending on age:

Infants and young children
• Frequent vomiting
• Feeding difficulties or refusal to eat
• Poor growth or weight gain

School-age children
• Ongoing reflux-like symptoms that don’t improve with standard reflux medicines
• Abdominal pain or nausea

Teens and adults
• Difficulty swallowing (dysphagia)
• Feeling of food sticking in the throat or chest
• Avoiding foods that are harder to chew or swallow (meats, bread, raw veggies)
• Sometimes this avoidance leads to an eating pattern called Avoidant/Restrictive Food Intake Disorder (ARFID)

Why does it happen?

- EoE is linked to how the immune system reacts to foods and sometimes environmental triggers.
- It is not the same as a food allergy in the typical sense. Standard allergies (like peanut or shellfish reactions) are immediate and cause hives or swelling.
- EoE is a delayed immune reaction — symptoms build up over time as inflammation develops in the esophagus.

How is EoE diagnosed?

- Endoscopy with biopsy is the only way to confirm EoE.
• During this procedure, a doctor looks inside the esophagus with a small camera.
• Tiny tissue samples are taken to check for eosinophils under the microscope.
- Allergy blood tests or skin tests are not enough to diagnose EoE.

Treatment options

The goal is to reduce inflammation, relieve symptoms, and prevent long-term damage (like scarring or narrowing of the esophagus). Common treatments in children include:

Swallowed steroid medications
• Budesonide (slurry or respules mixed into a liquid) – most commonly used.
• Fluticasone (Flovent) – swallowed from an inhaler, not inhaled.

Proton Pump Inhibitors (PPIs)
• Some children improve on medicines like omeprazole or lansoprazole.

Biologic therapy
• Dupilumab (Dupixent) is an injection approved for certain patients with EoE.

Why do we treat EoE?

- If inflammation is not controlled, the esophagus can develop scarring and narrowing over time.
- This may lead to food getting stuck (food impactions) and the need for esophageal dilations — a procedure where the esophagus is stretched to allow food to pass.
- While dilation can help in severe cases, the goal is to prevent narrowing from happening in the first place.
- Treating EoE early and consistently lowers the risk of long-term damage.

Monitoring and follow-up

- Symptoms alone don’t always tell us how active the disease is.
- Repeat endoscopies are needed to see if the esophagus is healing and to guide long-term treatment.
- Children with EoE usually need ongoing follow-up with their gastroenterology team.

Key points for families

- EoE is a chronic condition, but it can be managed well with treatment.
- It is not a typical food allergy — the immune reaction is delayed and different.
- Medicines that are swallowed, not inhaled, are the most common treatment.
- Treating inflammation prevents long-term scarring and the need for dilations.
- Ongoing monitoring is important to keep the esophagus healthy and prevent future complications.

References

 NASPGHAN. GI Kids: Patient Education Resources. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. https://www.gikids.org

 American Academy of Pediatrics (AAP). Pediatric Gastroenterology Clinical Reports and Patient Education. https://www.aap.org

 Blaufuss, T. Common Sense Pediatric GI: Practical Guidance for Families. Dakota Pediatric Gastroenterology, Fargo, ND, 2025.

 Papadopoulou A, Koletzko S, Heuschkel R, et al. ESPGHAN Guidelines for the Diagnosis and Management of Eosinophilic Esophagitis in Children. J Pediatr Gastroenterol Nutr. 2024;79(2):155-175.

 NASPGHAN. Eosinophilic Esophagitis. GI Kids.

 AAP. Eosinophilic Esophagitis in Children. HealthyChildren.org.