Eosinophilic Esophagitis

Diagnosis

Diagnosis of eosinophilic esophagitis (EoE) involves assessing symptoms, medical history, and specific test results. Your healthcare provider will also check for other possible conditions, such as gastroesophageal reflux disease (GERD), which can cause similar symptoms.

Tests used to diagnose eosinophilic esophagitis include:

• Upper endoscopy – A long, flexible tube (endoscope) with a light and camera is inserted through the mouth into the esophagus. The doctor examines the esophageal lining for inflammation, swelling, white spots, narrowing (strictures), and other irregularities. In some cases, the esophagus may appear normal.

• Biopsy – During the endoscopy, small tissue samples are taken from the esophagus and examined under a microscope to look for eosinophils, a type of white blood cell associated with allergic inflammation.

• Blood tests – Blood tests may be done to check for elevated eosinophil counts or higher levels of immunoglobulin E (IgE), which suggest allergic reactions.

• Esophageal sponge – This minimally invasive test involves swallowing a small capsule attached to a string. Once the capsule dissolves in the stomach, it releases a sponge that collects tissue samples as it is pulled out. This allows the provider to measure inflammation without performing an endoscopy.

Treatment

Eosinophilic esophagitis is a chronic, relapsing condition that often requires long-term management. Treatment aims to reduce inflammation, relieve symptoms, and prevent esophageal damage.

Dietary therapy

Depending on allergy test results, your healthcare provider may recommend removing certain foods from your diet. Common triggers include dairy, wheat, soy, eggs, nuts, and seafood. Eliminating specific foods or following an elimination diet can help reduce inflammation and improve symptoms.

Medication

• Proton pump inhibitors (PPIs) – Acid-blocking medications, such as omeprazole, are often the first line of treatment. They are easy to use but may not provide relief for all patients.

• Topical steroids – If PPIs are not effective, your provider may prescribe a swallowed corticosteroid, such as fluticasone or budesonide. These medications act directly on the esophagus and have fewer side effects than systemic steroids.

• Monoclonal antibodies – Dupilumab (Dupixent) is an FDA-approved monoclonal antibody used to treat eosinophilic esophagitis in adults and children aged 12 and older. It blocks specific proteins that cause inflammation and is administered via weekly injections.

Dilation

If eosinophilic esophagitis leads to esophageal narrowing (strictures), your provider may recommend esophageal dilation. This procedure stretches the narrowed area, helping to improve swallowing. Dilation is often considered when medications do not provide enough relief or when patients prefer to limit long-term drug use.