Eosinophilic esophagitis (EoE) is a condition that affects the esophagus, which is the tube through which food travels from your throat to your stomach. In EoE, white blood cells called eosinophils build up in the esophagus. Eosinophils aren’t typically found in the esophagus.

This buildup of eosinophils creates inflammation. The esophagus narrows, which can make it hard to swallow. In some cases, food gets stuck in the esophagus. EoE can also cause pain and heartburn symptoms.

It isn’t clear exactly why EoE develops. The buildup of eosinophils may be triggered by an allergic reaction. Unlike with typical allergies, the allergic response in EoE is delayed. This can make it harder to identify which foods might be causing EoE.

There are several treatment options for EoE. Medications can help reduce the immune response to lower inflammation, and dietary changes to eliminate trigger foods may also be effective.

The primary treatment options for EoE are medications and dietary changes.

Medications used for EoE include:

  • Proton pump inhibitors (PPIs): For some people, these are helpful for managing heartburn symptoms that are often part of EoE.
  • Steroids: These medications help lower inflammation in the esophagus to make it easier to swallow.
  • Biologics: Dupilumab (Dupixent) is a new biologic medication approved for EoE. It targets specific immune proteins that trigger inflammation in the esophagus.

Other treatments for EoE include:

  • Elimination diet: While on an elimination diet, you avoid some or all of the most common food allergens. This helps to reduce EoE symptoms. It’s also a way to identify foods that are triggering the allergic response.
  • Elemental diet: If an elimination diet doesn’t resolve symptoms, an elemental diet may be an option. On an elemental diet, you remove all solid food from your diet. You get your nutrition from an amino acid formula you may drink or receive through a feeding tube.
  • Esophageal dilation: This is a procedure to stretch and widen your esophagus, which makes it easier to swallow again. A doctor will do this if swallowing is really difficult or if you have had food stuck in your esophagus.

PPIs are often a first-line treatment for EoE. They reduce acid production in the stomach and may help reduce inflammation in the esophagus.

Not everyone’s EoE symptoms respond to PPIs. If that’s the case, other treatment options, such as steroids or biologics, may be prescribed.

Steroids or a new biologic medication, dupilumab, are often used to treat EoE. They help to reduce inflammation in the esophagus, which can reduce the risk of food getting stuck in it.

Steroids for EoE, which include fluticasone or budesonide, are swallowed so that they come in contact with the inner lining of the esophagus. But steroids don’t work for everyone. It’s estimated that about 1 in 3 people with EoE don’t respond to steroids.

Dupilumab, which is given as a weekly injection, works a little differently than a steroid. It blocks the specific immune proteins that cause inflammation in the esophagus. Steroids reduce the overall immune response.

Dupilumab is the first medication approved specifically to treat EoE. Other biologic drugs also show promise in treating EoE.

The other approach used to treat EoE is dietary changes. An elimination diet is an effective way to relieve and prevent symptoms. The most common elimination diet is the six-food elimination diet, which involves cutting out the foods most commonly associated with the allergic response in EoE. While following a six-food elimination diet, you avoid:

  • milk
  • wheat
  • eggs
  • nuts
  • soy
  • fish and shellfish

The six-food elimination diet has been shown to be effective for about 73% of people with EoE.

Other types of elimination diets only cut out some of the most common allergens. They are less restrictive but are often not as effective.

An elemental diet is shown to be very effective in treating EoE. One study in children showed that remission was achieved in 90% of participants. The cost and taste of an amino acid formula that’s used in an elemental diet may mean that it’s not a great option for everyone, however.

After doing an elimination diet or elemental diet, foods are gradually reintroduced. This helps to identify the specific foods you are allergic to that are causing the symptoms of EoE.

In May 2022, the FDA approved the first treatment specifically for EoE: dupilumab. It’s an injected biologic drug for adults and children ages 12 and up who weigh at least 40 kilograms (88 lbs).

Dupilumab targets specific immune proteins that create inflammation in the esophagus. When those proteins are blocked, symptoms are reduced.

Clinical trials showed that after 12 weeks of weekly dupilumab injections, 83% of participants with EoE experienced a significant reduction in eosinophil levels and improvement in EoE symptoms.

There are other biologic drugs currently in trials to treat EoE. Many of these are already used to treat other inflammatory conditions related to EoE. There’s hope that they’ll also work for EoE.

Making dietary changes can often help reduce inflammation and relieve EoE symptoms.

Symptoms of EoE are often triggered by a food allergy. EoE is different from other food allergies, however. Usually, signs and symptoms show up immediately after a person eats the food they’re allergic to. But with EoE, the allergic reaction is delayed. This can make it more complicated to figure out which foods are causing the allergic reaction.

The only way to know for sure what foods are causing EoE symptoms is through an elimination diet. A skin prick test doesn’t accurately identify the foods that trigger EoE. There are different types of elimination diets. A six-food elimination diet, already discussed above, has the best results.

After the elimination period, you will have an endoscopy. During an endoscopy, a doctor inserts a long, flexible tube with a camera to inspect your esophagus for inflammation as well as other potential signs of EoE, such as swelling, white spots, and horizontal rings. A doctor may also perform a biopsy to check the levels of eosinophils in the esophagus.

Another type of elimination diet is the four-food elimination diet. For this diet, you avoid:

  • milk
  • wheat
  • eggs
  • soy

This diet is easier to follow than the six-food elimination diet but has lower success rates. Around 41% to 60% of people with EoE achieve remission on a four-food elimination diet.

Once EoE is in remission, foods can be gradually reintroduced. Throughout this process, you will monitor your symptoms. You will likely have regular endoscopies to look for inflammation.

Research suggests that up to 31% of people with EoE will have more than one food trigger. Milk and wheat should be reintroduced last since these are the most common triggers for EoE.

The elemental diet is the most restrictive dietary approach used for EoE. It involves removing all foods from your diet and exclusively drinking an amino acid formula for at least 6 weeks. In some cases, people may need to use a feeding tube instead.

This diet is very effective and has a remission rate of about 90%. But it can be difficult to follow due to the taste and cost of the formula and the restrictive nature of the diet. The elemental diet is typically recommended as a temporary or rescue therapy for people whose EoE hasn’t responded to other treatments.

Eosinophilic esophagitis (EoE) is a condition in which white blood cells called eosinophils build up in your esophagus. This can cause inflammation, pain, and swallowing difficulties. It is often caused by an allergic reaction to food.

Treatments for EoE include steroids and biologic medications. These both work to lower the immune response to reduce inflammation.

Your diet can also play an important role in managing EoE. There are structured elimination diets where you cut out the six most common allergens. Many people are able to achieve remission with an elimination diet. It also helps to identify which foods are causing the allergic reaction.

Regular contact with your healthcare team is important to monitor your symptoms with any EoE treatments.