Eosinophilic oesophagitis is a chronic inflammatory condition where certain white blood cells gather in the tube connecting your mouth to your stomach, causing difficulty swallowing and other symptoms that can significantly affect daily life.
Understanding Eosinophilic Oesophagitis
Eosinophilic oesophagitis, sometimes called EoE, is a long-term condition that affects the oesophagus, which is the muscular tube that carries food and liquids from your mouth down to your stomach. When you have this condition, a type of white blood cell called an eosinophil builds up in large numbers in the lining of your oesophagus. Normally, these cells are not found in the oesophagus at all, but in people with EoE, they migrate there and cause problems.[1][2]
The presence of these eosinophils triggers inflammation, which is swelling and irritation of the tissue. Over time, this ongoing inflammation can injure the oesophageal tissue and make it difficult for food to pass through properly. When left without treatment, the inflammation can lead to scarring and narrowing of the oesophagus, making swallowing increasingly difficult. Some people describe feeling like food is moving very slowly or getting stuck when they try to swallow.[2]
This is not a condition that simply goes away on its own. EoE is considered a chronic disease, meaning it is long-lasting and requires ongoing management. While there is no cure available at this time, there are various treatments that can help control the inflammation and manage the symptoms effectively. Most people who are diagnosed with eosinophilic oesophagitis will need some form of treatment for the rest of their lives to keep the condition under control.[2][3]
How Common Is Eosinophilic Oesophagitis
Eosinophilic oesophagitis was once considered a rare condition that was only occasionally reported in medical literature. However, the number of cases being diagnosed has increased significantly over recent decades. This rise in diagnoses is partly due to better awareness among doctors and improved diagnostic methods, though the actual occurrence of the disease also appears to be increasing.[2][9]
Current estimates suggest that approximately 34 in 100,000 people are affected by this condition. Another way to understand this is that roughly 1 out of every 1,700 people may have eosinophilic oesophagitis, making it more common than previously thought. In the United States alone, around 160,000 people are believed to be living with EoE.[2][3][6]
This condition can affect anyone, regardless of age. Infants, children, teenagers, and adults can all develop eosinophilic oesophagitis. However, certain groups are more likely to be affected than others. The condition is more frequently diagnosed in males than in females. People of all ethnic backgrounds can develop EoE, though it has been studied most extensively in certain populations.[2][3][7]
Interestingly, while the disease was first described in children, researchers now recognize that it commonly continues into adulthood and can also first appear in adult life. Many adults who are diagnosed with eosinophilic oesophagitis have actually had symptoms for years but were not correctly diagnosed until later in life. This delay often occurs because the symptoms can be similar to other, more common digestive conditions.[1][4]
What Causes Eosinophilic Oesophagitis
The exact cause of eosinophilic oesophagitis is not completely understood, but researchers believe it is primarily an immune system reaction to certain substances. The condition is classified as a food allergy, though it differs from typical food allergies that cause immediate reactions like hives or breathing difficulties. Instead, EoE involves a delayed immune response that builds up over time in the oesophagus.[2][3]
When someone with EoE eats certain foods, their immune system identifies these foods as threats and responds by sending eosinophils to the oesophagus. These white blood cells then release substances into the surrounding tissue that cause inflammation and damage. The foods that trigger this reaction are not the same for everyone with EoE, which makes the condition challenging to manage. What causes symptoms in one person may not cause any problems in another.[2][4]
The most common food triggers that have been identified include animal milk and dairy products, eggs, peanuts and tree nuts, seafood and shellfish, soy, and wheat. These six foods are responsible for most cases of eosinophilic oesophagitis, though other foods can also trigger the condition in some individuals. It’s important to note that the specific foods causing problems need to be identified for each person through careful testing and dietary changes.[2]
Besides food triggers, environmental allergens may also play a role in some cases. Substances like dust mites, animal dander, pollen, and moulds have been suggested as potential contributors to EoE. Many people with eosinophilic oesophagitis also have environmental allergies, which suggests a connection between these allergen exposures and the development or worsening of the condition.[6]
Genetics also appear to play a significant role in who develops eosinophilic oesophagitis. Researchers have identified multiple genes that may increase a person’s risk of developing the condition. These genes are involved in immune system function, particularly in the type of immune response that involves eosinophils. Certain families seem to have an inherited tendency to develop EoE, suggesting that the condition can run in families.[4][7]
Risk Factors for Developing Eosinophilic Oesophagitis
Several factors increase the likelihood that a person will develop eosinophilic oesophagitis. Understanding these risk factors can help both patients and doctors recognize the condition earlier and begin appropriate treatment sooner. One of the most significant risk factors is being male, as men and boys are diagnosed with EoE more frequently than women and girls.[3][7]
Having other allergic conditions is another major risk factor. Many people with eosinophilic oesophagitis also have asthma, which is a chronic lung condition that causes breathing difficulties. Similarly, allergic rhinitis, commonly known as hay fever, is frequently seen in people with EoE. This condition causes sneezing, congestion, and a runny nose in response to allergens like pollen or dust.[2][7]
Skin conditions related to allergies are also commonly associated with eosinophilic oesophagitis. Atopic dermatitis and eczema are conditions that cause red, itchy, and inflamed skin, often in response to allergens or irritants. People who have these skin conditions appear to be at higher risk of developing EoE. Food allergies of any type also increase the risk, even if those food allergies cause different symptoms than EoE.[2][7]
Family history is another important risk factor. If you have close relatives who have been diagnosed with eosinophilic oesophagitis, your own risk of developing the condition is higher than that of the general population. This familial tendency supports the idea that genetic factors play a significant role in the development of EoE.[2][7]
Recognizing the Symptoms of Eosinophilic Oesophagitis
The symptoms of eosinophilic oesophagitis vary considerably depending on the age of the person affected. This variation in symptoms across different age groups can sometimes make the condition difficult to recognize and diagnose. In infants and toddlers, the signs are often related to feeding difficulties. Very young children with EoE may refuse to eat or drink, making mealtimes stressful for the whole family. They may also vomit frequently and have trouble gaining weight or growing at the expected rate, a condition doctors call failure to thrive.[2][5][7]
School-age children with eosinophilic oesophagitis typically present with different symptoms. They may complain of recurring abdominal pain or stomach aches. Vomiting can continue to be a problem in this age group. Many children begin to experience difficulty swallowing, particularly with certain types of food. They may also develop a decreased appetite and show little interest in eating, which parents may initially attribute to pickiness or behavioural issues.[5][7]
Teenagers and adults with EoE most commonly experience difficulty swallowing, known medically as dysphagia. This symptom often starts gradually and gets worse over time. People may notice that they have particular trouble swallowing dry or dense solid foods like bread, meat, or raw vegetables. To cope with this difficulty, many people unconsciously change their eating habits. They might chew their food much longer than necessary, take smaller bites, drink large amounts of liquid with meals to wash food down, or avoid certain foods altogether.[1][5]
One of the most serious symptoms of eosinophilic oesophagitis is food impaction, which occurs when food becomes firmly stuck in the oesophagus and cannot move down to the stomach. This is not simply a feeling of discomfort but rather a medical emergency where the food physically blocks the oesophagus. When this happens, a person cannot swallow anything else, including liquids or saliva. Food impaction can be frightening and painful, and it may require emergency medical treatment to remove the stuck food. This complication is more common in adults with EoE, particularly those who have had untreated inflammation for a long time.[2][5]
Many people with eosinophilic oesophagitis experience symptoms that resemble gastroesophageal reflux disease, commonly known as GERD or acid reflux. These symptoms include heartburn, which is a burning sensation in the chest, and regurgitation, where food comes back up into the mouth after being swallowed. Chest pain or chest discomfort is also common. Because these symptoms are similar to those of acid reflux, many people with EoE are initially diagnosed with GERD. However, a key distinguishing feature is that EoE symptoms do not improve with medications that reduce stomach acid, which typically work well for GERD.[1][2][6]
Additional symptoms that can occur at any age include nausea, which is a feeling of wanting to vomit, and actual vomiting. Some people experience abdominal or belly pain. The pattern of symptoms can also vary within the same person over time. Some individuals have symptoms constantly, while others experience periods when symptoms come and go, which doctors call flare-ups.[2]
Preventing Eosinophilic Oesophagitis
Currently, there is no known way to prevent eosinophilic oesophagitis from developing in the first place, as the exact causes are not fully understood and likely involve a combination of genetic and environmental factors. However, once a person has been diagnosed with EoE, identifying and avoiding the specific triggers that cause inflammation can help prevent symptoms and complications.[2]
For people who have been diagnosed with eosinophilic oesophagitis, dietary management plays a crucial role in preventing symptom flare-ups and reducing inflammation. Working with healthcare providers to identify which foods trigger the condition allows people to make informed decisions about what they eat. This often involves carefully eliminating certain foods from the diet and then gradually reintroducing them one at a time while monitoring symptoms and, in some cases, having repeat medical examinations to check the level of inflammation.[12]
If environmental allergens contribute to a person’s EoE, taking steps to reduce exposure to these allergens may help. This might include measures to reduce dust mites in the home, such as using allergen-proof covers on mattresses and pillows, washing bedding frequently in hot water, and reducing clutter where dust can accumulate. For people allergic to pet dander, minimizing close contact with animals or keeping pets out of bedrooms may be helpful.[6]
Regular follow-up with healthcare providers is important for preventing complications of eosinophilic oesophagitis. Even when symptoms are well-controlled, ongoing inflammation can continue to cause damage to the oesophagus. Staying consistent with prescribed treatments, whether dietary changes or medications, helps prevent the long-term complications of EoE, such as scarring and narrowing of the oesophagus.[2]
How Eosinophilic Oesophagitis Changes Normal Body Functions
To understand how eosinophilic oesophagitis affects the body, it helps to know how the oesophagus normally works. The oesophagus is a muscular tube that uses coordinated contractions to push food and liquids from the throat down to the stomach. The lining of the oesophagus is made of layers of cells that form a protective barrier. In a healthy person, the oesophagus does not contain eosinophils, which are white blood cells normally found in other parts of the digestive system and in the blood.[4][5]
In eosinophilic oesophagitis, the immune system mistakenly identifies certain food proteins or other substances as dangerous invaders. This triggers a complex immune response involving multiple types of cells and chemical messengers. The cells lining the oesophagus release inflammatory signals called cytokines, including substances known as IL-33 and thymic stromal lymphopoietin. These signals attract immune cells, particularly a type of white blood cell called a T-helper 2 cell, to the oesophagus.[4]
These immune cells, in turn, release additional inflammatory signals that call eosinophils to migrate from the bloodstream into the oesophageal tissue. Once there, the eosinophils release toxic substances and enzymes that are normally used to fight parasites and other invaders. However, in EoE, these substances instead damage the oesophageal lining. The damage causes inflammation, which shows up as redness and swelling when doctors examine the oesophagus.[4]
Over time, chronic inflammation leads to changes in the structure of the oesophagus. The tissue can develop visible abnormalities that doctors can see during an examination. These may include rings that encircle the oesophagus, making it look like a stack of rings or a corrugated tube. Vertical furrows or grooves may form, running up and down the length of the oesophagus. White spots or patches of eosinophils may be visible on the surface. The oesophagus may also become narrowed, with areas of stricture where the passage has become so tight that food can easily get stuck.[1][8]
The ongoing inflammation also affects how well the oesophagus can stretch and contract. The tissue may become stiff and less flexible, a process called fibrosis or scarring. This stiffening makes it difficult for food to pass through normally, even when the muscles of the oesophagus are working correctly. In severe cases, the combination of narrowing and stiffening can make swallowing extremely difficult and increase the risk of food impaction.[2]
Another important change is that the protective barrier function of the oesophageal lining becomes impaired. The cells that normally form a tight barrier start to separate, allowing allergens and other substances to penetrate deeper into the tissue. This can worsen the inflammatory response and create a cycle where inflammation leads to barrier damage, which leads to more inflammation.[4]
The changes in the oesophagus are not just structural but also functional. The coordinated muscle contractions that normally move food smoothly down the oesophagus may become less effective. Combined with the narrowing and inflammation, this can make eating a slow and uncomfortable process. People may feel like they need to drink large amounts of liquid to help food move down, or they may find themselves coughing or gagging when trying to swallow certain foods.[1]
What makes eosinophilic oesophagitis particularly complex is that these changes develop gradually. Many people adapt their eating habits without realizing their oesophagus is becoming damaged. By the time they seek medical help, significant inflammation and structural changes may have already occurred. However, with appropriate treatment, the inflammation can be reduced, and some of the changes to the oesophagus can improve, though established scarring may be permanent.[2]
