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Eosinophilic Oesophagitis

Summary

Eosinophilic oesophagitis (EoE) is a long-term condition caused by an immune or allergic reaction affecting the oesophagus (the tube that carries food from the mouth to the stomach). It leads to inflammation and difficulty swallowing. The condition is becoming more common, especially in children and young adults.

Symptoms can vary by age:

  • Children may experience vomiting, heartburn, stomach pain, difficulty feeding, or poor growth.
  • Adolescents and adults may have difficulty swallowing (dysphagia) or food getting stuck in the throat (food impaction).

Treatment options include medications or dietary changes, and most people respond well to these approaches.

Diagnosis and When to Seek Help

If your child or a family member experiences frequent difficulty swallowing, persistent heartburn, vomiting, or unexplained feeding issues, it’s important to consult a doctor.

EoE is diagnosed through an endoscopy, where a small sample of the oesophagus lining (biopsy) is taken. The condition is confirmed if the sample shows an increased number of eosinophils (a type of immune cell linked to allergies).

Management

EoE is a chronic condition, but symptoms can be controlled with:

  • Medications – Doctors may prescribe swallowed corticosteroids or proton pump inhibitors (acid-reducing medication) to reduce inflammation.
  • Dietary changes – Some people benefit from eliminating certain food allergens, such as dairy, wheat, eggs, soy, nuts, or seafood.
  • Endoscopic dilation – In severe cases where the oesophagus becomes too narrow, a procedure may be needed to widen it.

Follow-Up and Monitoring

Regular check-ups with a doctor are essential to track symptoms and adjust treatment. Follow-up endoscopies may be needed to assess healing. Since EoE is a long-term condition, ongoing management helps prevent complications and improves quality of life.

If you suspect EoE in your child or family member, early diagnosis and treatment can help manage symptoms effectively.

History and Exam

Key diagnostic factor

  • presence of risk factors
  • dysphagia
  • food avoidance and modification behaviours

Other diagnostic factors

  • heartburn
  • chest discomfort
  • nausea/vomiting
  • regurgitation

Risk factor

  • family history of EoO
  • male sex
  • atopic disease
  • children and younger adults

Diagnostic Investigations

1st investigations to order

  • oesophagogastroduodenoscopy
  • oesophageal biopsy
  • FBC with differential

Investigations to consider

  • transnasal endoscopy
  • oesophageal string test
  • cytosponge
  • Oesophageal physiological testing

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    Other Related Conditions

    coeliac disease

    Inflammatory bowel disease (Crohn’s disease or Ulcerative Colitis)

    Eosinophilic Oesophagitis

    cow’s milk protein intolerance, food allergies

    irritable bowel syndrome (ibs)

    reflux & vomiting

    failure to thrive

    constipation or diarrhoea

    incontinence

    chronic abdominal pain

    gastroparesis

    liver disease

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      1 Reason for referral *

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      3 Patient First Name *

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      6 Phone *

      7 Child’s date of birth *

      8 Address