If you have eosinophilic esophagitis (EoE) – even if you’re not sure of a diagnosis yet – the symptoms will flag a problem. For example, you might have a hard time swallowing or keeping food down, have chest pain that antacids don’t ease, get food stuck in your throat, or other signs that your esophagus isn’t working properly.
But even clear-cut symptoms can make EoE tricky to diagnose because they can closely mirror other conditions. The good news is, your doctor can run tests to tease out the right diagnosis and get you on the right path to treatment.
What Is EoE?
EoE happens when too many eosinophilia – a kind of white blood cell – build up and cause swelling in your esophagus, the tube of
muscle that sends food from your mouth to your stomach. When the esophagus can’t do its job, you might have problems eating or keeping food down.
Other symptoms might include:
- Stomach pain
- Heartburn – a burning feeling in the center of your chest – or other chest pain
- Vomiting even when you try meds for reflux
- Food getting stuck in your throat (medical emergency)
Unlike temporary conditions that might come and go, or only happen sometimes, EoE symptoms are chronic, meaning ongoing. EoE is common in both children and adults, especially males in both populations. It’s seen most in white men in their 20s and 30s.
What Causes EoE?
EoE is somewhat new as a recognized disease, so researchers haven’t zeroed in on the exact causes yet. Right now, some scientists think your immune system’s reaction to certain foods or organisms in the environment might trigger it. For example, your doctor might want to find out if you’re allergic to pollen, mold, animal dander, or dust mites.
The tendency to get EoE also might run in families. The same symptoms happen in other diseases and illnesses, too, which can make diagnosing EoE tricky.
Similar Symptoms, Different Diseases
GERD. Before the esophagus was recognized as part of the immune system, allowing researchers to look at outside factors, EoE was thought to be akin to GERD, or gastroesophageal reflux disease. The confusion stemmed from the two conditions sharing many symptoms.
Other symptoms of GERD that mimic EoE include:
- Heartburn
- Problems or pain when you swallow
- Vomiting
- General chest pain
A few signs that may differ is GERD can come with:
- Hoarseness
- Coughing
The origins of the two diseases are very different, though. While EoE suggests something allergen-related is happening, scientists believe GERD comes from an injury to the mucous membranes in your esophagus. This might be due to repeated acid reflux -- when stomach acid backs up into your esophagus.
GERD also can happen if your lower esophageal sphincter -- where your esophagus meets your stomach and which protects against reflux -- gets weak or relaxes when it shouldn’t. Causes might include being overweight, pregnancy, smoking, or breathing in secondhand smoke. Some medications, like sedatives, asthma meds, or NSAIDs, can cause it, too.
PPI-REE. Proton pump inhibitor-responsive esophageal eosinophilia, aka PPI-REE, is so similar to EoE that some researchers view it as a subtype. Proton pump inhibitors, or PPIs, are drugs that reduce stomach acid. They’re a standard treatment for GERD and have been used in the past to tell it apart from EoE because EoE doesn’t always respond to PPIs.
But some people with EoE do respond to PPIs; hence the name PPI-REE. For this reason, PPIs have been made part of the treatment. If they don’t work, your doctor can try another approach.
Other Conditions With Similar Symptoms
Other isolated symptoms or conditions -- meaning they happen on their own and not always with others -- can mimic the signs of EoE. These include:
- Viral gastroenteritis (aka stomach "bug" or flu)
- Reflux
- Constipation
- Frequent upset stomach
- Feeling that something’s stuck in your throat
Getting the Right Diagnosis
Your doctor will take you through a series of steps to find out if you have EoE or something else:
- Get a thorough medical history. They’ll ask you about your specific symptoms and background in order to rule out other conditions that can seem like EoE.
- Do an upper GI (gastrointestinal) endoscopy. Your doctor will use a long, bendable tube with a tiny camera and light on the tip to look at your esophagus. Signs like swelling, white spots, rings, or narrowing might point to EoE. Not everyone with EoE has them, though, and they can also be from other conditions.
- Run a biopsy. Your doctor will get some small tissue samples from your esophagus during the endoscopy to send to a lab for study. They’ll be checking how many eosinophils are in the samples -- the final step for EoE diagnosis.
- Blood or allergy tests if needed. They can help ID other conditions or pinpoint other problems if you have EoE.
New FDA-Approved Treatment
Until recently, EoE treatments were mostly limited to PPIs, elimination diets, long-term dietary changes, and swallowed topical steroids to ease inflammation. These didn’t always address severe symptoms, though. Now there is a medication to try if these other treatments don't help. In 2022, the FDA issued its first approval of a drug for EoE. Dupilumab (Dupixent) is made of proteins that target your immune system. A recent trial in preteens to young adults showed the drug eased EoE symptoms and improved tissue condition.
Dupilumab was originally developed to treat serious cases of atopic dermatitis, also called eczema, which causes itchy, swollen skin. It’s also prescribed for asthma as well as for people who have polyps, or growths, in their nasal passages.
In treatment for EoE, dupilumab can be prescribed to adults and children 12 and up who have average weight.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Mayo Clinic: "Eosinophilic Esophagitis," "Gastroesophogeal Reflux Disease," "Viral Gastroenteritis (Stomach Flu)," "Functional Dyspepsia," "Atopic Dermatitis (Eczema)."
American Family Physician: "Eosinophilic Esophagitis: A Mimic of Gastroesophageal Reflux Disease."
Cleveland Clinic: "Eosinophilic Esophagitis," "Esophagus," "Heartburn," "Proton Pump Inhibitors."
Johns Hopkins Medicine: "Eosinophilic Esophagitis."
Medline Plus: "Eosinophilic Esophagitis."
StatPearls: "Eosinophilic Esophagitis," "Physiology, Lower Esophageal Sphincter."
National Institute of Diabetes and Digestive and Kidney Diseases: "Symptoms and Causes of GER and GERD."
The Journal of Allergy and Clinical Immunology: "Histologic similarities in children with eosinophilic esophagitis and proton pump inhibitor–responsive esophageal eosinophilia."
Therapeutic Advances in Gastroenterology: "Evidence-based treatments for eosinophilic esophagitis: insights for the clinician."
American Academy of Pediatrics: "Diagnosis of Eosinophilic Esophagitis."
UpToDate: "Globus Sensation."
FDA: "FDA Approves First Treatment for Eosinophilic Esophagitis, a Chronic Immune Disorder."
Children's Hospital of Philadelphia: "Promising Use for Antibody Treatment for EoE."
American College of Allergy, Asthma, & Immunology: "Chronic Rhinosinusitis With Nasal Polyps."
