May 28, 2026 | Black & Kletz Allergy
Eosinophilic esophagitis (EoE) is an illness caused by long-standing inflammation of the esophagus, the muscular tube that carries food from the mouth to the stomach.
Eosinophilic esophagitis may occur as a result of an allergy to certain foods or a food trigger, which are not the same for all individuals. It occurs when eosinophils (i.e., a certain type of white blood cell) accumulates in the esophagus, causing irritation and scarring of the esophagus. Some patients with eosinophilic esophagitis will also have other areas of the digestive tract affected with increased eosinophils, including the stomach, small intestine, and/or large intestine (i.e., colon). Eosinophilic infiltration of other parts of the gastrointestinal system, (i.e., stomach, small intestine, large intestine) is rare but more likely to occur in children.
Eosinophilic esophagitis can affect all age groups, beginning in infancy. More males are affected than females. It is estimated to occur in 1 out of 1,700 people. Certain families may have an inherited tendency to develop eosinophilic esophagitis as it is thought to result from a combination of genetic, immune, and environmental factors.
Many patients with eosinophilic esophagitis also have food and/or environmental allergies. Individuals with eosinophilic esophagitis commonly have other allergic diseases, such as allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), asthma, or eczema (i.e., atopic dermatitis). While the exact cause of eosinophilic esophagitis is not known at this point, the general belief is that it is typically caused by an immune response to specific foods.
The classic symptoms described by patients with eosinophilic esophagitis typically include trouble swallowing, heartburn, and/or a feeling that food is getting stuck in the throat. Many individuals also exhibit adaptive or coping behaviors that they naturally developed as a way to be more comfortable with the symptoms that they have lived with, not knowing what is causing their symptoms. Doctors have described this change in eating behavior by the acronym IMPACT:
- Imbibe fluids – Ingesting fluids with meals to help food go down.
- Modify foods – Cutting food into tiny pieces, softening it, pureeing it.
- Prolong mealtimes – Taking unusually long to eat.
- Avoid hard texture foods – Avoiding bread, steak, dry rice, dense meats, raw vegetables, etc.
- Chew excessively – Over-chewing to prevent food getting stuck.
- Turn away tablets/pills – Avoiding pills because they feel difficult to swallow.
Below are the highlights of the most recently updated guidelines:
- The diagnosis of eosinophilic esophagitis is done by checking for symptoms of esophageal dysfunction, such as trouble swallowing or regurgitating food, finding 15 or more eosinophils per high powered field in the esophageal tissue samples taken during biopsy, and ruling out other possible conditions.
- The recommendation is to use a standard scoring system during every endoscopy and to take at least 6 tissue samples (i.e., biopsies) from at least 2 parts of the esophagus to be examined under a microscope.
- In the treatment of eosinophilic esophagitis, guidelines support the use of medical therapy including proton pump inhibitors (PPIs) or swallowed topical steroids.
- A trial of elimination of 1 or 2 foods from the diet (dairy and/or wheat) while closely monitoring symptoms.
- If patients do not respond to these approaches, the biologic Dupixent (i.e., dupilumab) may be used.
- For children with eosinophilic esophagitis and feeding difficulties, a feeding therapist or dietitian to help with therapy is recommended.
- Continue to monitor symptoms and perform endoscopies with biopsies so that the tissue samples can be examined under a microscope.
The guidelines emphasize the importance of addressing both the inflammation and any scarring or narrowing of the esophagus when treating and monitoring patients with eosinophilic esophagitis.
If you think that you may have eosinophilic esophagitis, or any other type of allergy, the board certified allergy doctors at Black & Kletz Allergy would be happy to help you. We have 3 convenient offices in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking. Our Washington, DC and McLean, VA locations are Metro accessible. There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call us for an appointment. Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy have been treating both children and adults in the DC metro area for eosinophilic disorders, allergies, asthma, sinus disease, and immunologic disorders for more than 5 decades. We strive to provide top-of-the-line allergy relief in a thoughtful and professional environment.
