Navigating Eosinophilic Esophagitis: From Symptoms to Solutions
Eosinophilic esophagitis (EoE) is a chronic immune or antigen-mediated process - initiated or influenced by the presence and interaction of antigens with the immune system. EoE causes inflammation of the esophagus and a buildup of eosinophils.
Previously, EoE was thought to be a component of gastroesophageal reflux disease (GERD), however, it is now understood to be a separate issue as research has demonstrated that the esophagus is an active immunogenic organ (Roussel & Pandit, 2023). This means that the cells of the immune system are present in the esophagus, specifically in the esophageal mucosa. These cells are vital in sustaining esophageal health, protecting against infections, and responding to stimuli. Eosinophils, a type of white blood cells, are typically not present in a healthy esophagus, however, in those with EoE eosinophils are present, lending to the pathological diagnosis (Roussel & Pandit, 2023).
The etiology of EoE is unknown, however, it is hypothesized that EoE may be caused by genetic factors, environmental interactions, and host immune factors (Roussel & Pandit, 2023). Additionally, there is a strong correlation between patients’ genetic predisposition to develop allergic diseases and the development of EoE (Dellon et al., 2018). EoE may result in vomiting, dysphagia, chest discomfort, heartburn, difficulty feeding, food intolerance, abdominal pain, weight loss and food impaction (Beveridge et al., 2025; Muir & Falk, 2021; Roussel & Pandit, 2023). A past medical history significant for atopic conditions such as seasonal allergies, food allergies, eczema, and other issue may also be present (Dellon et al., 2018).
It is recommended that EoE is only diagnosed based on clinical, endoscopic, and histopathologic evaluations. Wen & Rothenberg, (2017) recommend that an upper endoscopy be completed when patients present with food impaction, dysphagia, and a history of atopy. Additionally, an upper endoscopy with esophageal biopsy of the proximal, mid and distal esophagus is recommended when it is presumed that patients have a diagnosis of GERD but are resistant to optimal proton pump inhibitor (PPI) usage (Roussel & Pandit, 2023). Endoscopy may reveal corrugated mucosa, longitudinal mucosal furrows, fixed esophageal rings or trachealization, whitish mucosal plaque, stricture, mucosal tearing, and narrowing of the lumen, however, it is important to note that some patients may have normal esophageal presentation during the upper endoscopy (Lucendo et al., 2017; Roussel & Pandit, 2023).
When eosinophils are present at 15 per high power field or higher, a pathological diagnosis is made, however, other findings indicative of EoE include elongation of the papillae, extracellular eosinophilic granules, basal cell hyperplasia, among other findings (Roussel & Pandit, 2023; Wen & Rothenberg, 2017). Additionally, a modified barium swallow study or a barium swallow study may uncover strictures or a ringed esophagus that could be caused by EoE (Roussel & Pandit, 2023).
Treatment options for EoE may include proton pump inhibitors (EoE), topical steroids, empiric diet elimination, a biologic, and esophageal dilation while clinical, endoscopic, and histologic assessments are all recommended tools to monitor individual treatment response (Dellon et al., 2025). To learn more about EoE, check out the references cited here.
