Eosinophilic Esophagitis (EoE)

EoE is a chronic, immune-mediated esophageal disease characterized by symptoms of esophageal dysfunction and ≥15 eosinophils per high-power field on biopsy. It is associated with atopy (allergic rhinitis, asthma, eczema, food allergies).

Symptoms

• Solid food dysphagia
• Food impaction requiring emergency removal
• Chest pain, heartburn refractory to PPIs
• Feeding difficulties, failure to thrive in children
• Slowly progressive esophageal remodeling leading to strictures

Diagnosis

• Upper endoscopy with biopsies from multiple levels showing eosinophilia
• Endoscopic findings: rings (trachealization), furrows, white exudates, edema, strictures
• Exclude other causes (GERD, achalasia, infection)
• PPI trial (8 weeks) historically recommended; now PPIs considered treatment rather than diagnostic filter

Treatment Strategy

3-D: Diet, Drugs, Dilation

1. Dietary Therapy

• Six-food elimination (milk, wheat, egg, soy, nuts, seafood) or step-up elimination guided by allergy testing
• Elemental diet (amino acid-based formula) for severe cases
• Reintroduce foods sequentially with repeat endoscopy/biopsy to identify triggers

2. Drugs

• Proton pump inhibitors (anti-inflammatory effect)
• Swallowed topical corticosteroids: fluticasone MDI swallowed, budesonide slurry/orodispersible tablet
• Dupilumab approved for moderate-severe EoE in adolescents/adults
• Budesonide oral suspension (FDA-approved)

3. Dilation

• Endoscopic dilation for strictures and narrow-caliber esophagus (with caution due to perforation risk)

Monitoring

• Symptom tracking alone insufficient; periodic endoscopy/biopsy to assess histologic remission
• EREFS scoring for endoscopic severity
• Watch for steroid side effects (thrush, adrenal suppression rare)

Lifestyle & Support

• Slow chewing, thorough hydration with meals
• Avoid temperature-extreme foods that trigger spasm
• Carry action plan for food impaction (seek emergency care if unable to swallow saliva)
• Nutritionist/allergist collaboration for elimination diets
• Mental health support; restrictive diets impact social life

Complications

• Food impaction, esophageal strictures
• Weight loss/malnutrition in severe elimination diets
• Anxiety around eating

Research & Future Directions

Biologics targeting IL-13, IL-4, IL-5, and Siglec-8, as well as novel topical formulations, are under investigation.

Experimental & Emerging Treatments

• Anti-IL-5 Therapies (mepolizumab, benralizumab) for eosinophil depletion.
• Anti-Siglec-8 (lirentelimab): Targets mast cells/eosinophils.
• JAK Inhibitors & S1P Modulators: Oral agents reducing esophageal inflammation.
• Biomarker Monitoring (EoE Diagnostic Panel): Less invasive testing using esophageal string test or cytosponge.

Track EoE with Diagnoza.care

Eat Confidently with Data – Log meals, elimination phases, symptoms, medication doses, dupilumab injections, endoscopy/biopsy results, dilations, and nutrition/allergy visits; capture side effects; and let the AI companion highlight trigger foods and histologic responses.

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Medical Disclaimer: Informational only. Work with your gastroenterologist/allergist to personalize elimination diets, medications, and monitoring intervals. Sources: American College of Gastroenterology, American Gastroenterological Association, Consortium of Eosinophilic Gastrointestinal Disease Researchers