Understanding Eosinophilic Esophagitis: When Acid Reflux Is a Symptom of Something More
- volcanowishes
- Apr 9
- 3 min read
If you’ve been living with heartburn, trouble swallowing, or the feeling that food gets stuck in your throat, you might assume it’s just acid reflux. But what if those familiar symptoms were pointing to something else entirely?
Eosinophilic Esophagitis (EoE) is a chronic, often misdiagnosed condition that affects the esophagus—the tube that connects your mouth to your stomach. While it shares many symptoms with acid reflux, EoE is actually an allergic, immune-driven inflammation that requires a very different approach to treatment.
If reflux treatments haven’t been working, or you’ve noticed ongoing swallowing issues, this article is for you.
What Is EoE?
Eosinophilic Esophagitis is an inflammatory condition where a specific type of white blood cell, the eosinophil, builds up in the lining of the esophagus. These cells are usually involved in allergic responses and are not typically found in the esophagus. Their presence triggers chronic inflammation, leading to scarring, narrowing, and difficulty swallowing.
While EoE was once considered rare, it's now recognized as a leading cause of swallowing difficulties and food impaction—particularly in children and young adults.
Symptoms to Watch For
EoE symptoms can vary depending on age and the extent of inflammation. They often mimic other digestive issues like acid reflux, but don’t respond to standard reflux treatments.
In Adults
Difficulty swallowing (dysphagia)
Sensation of food getting stuck
Chest pain (not related to heart conditions)
Chronic heartburn or reflux symptoms that don’t improve with medication
In Children
Poor appetite or picky eating
Trouble gaining weight
Nausea, vomiting, or belly pain
Refusal to eat certain textures of food
EoE vs. Acid Reflux: What’s the Connection?
Because EoE and acid reflux (or GERD—gastroesophageal reflux disease) share similar symptoms, they are often confused. But they are very different conditions with different causes and treatments.
Similarities:
Both can cause heartburn, chest discomfort, and trouble swallowing.
Both may respond initially to proton pump inhibitors (PPIs), though for different reasons.
Both involve inflammation of the esophagus.
Key Differences:
Feature | EoE | Acid Reflux (GERD) |
Cause | Allergic/immune reaction to foods or allergens | Stomach acid flowing backward into the esophagus |
Cell involvement | Eosinophils (allergy-related white blood cells) | No eosinophils; primarily acid-related damage |
Response to PPIs | May or may not help | Often improves symptoms |
Treatment focus | Allergy avoidance, topical steroids | Acid suppression, lifestyle changes |
Tissue changes | Chronic inflammation, scarring, strictures | Erosion, ulceration, Barrett’s esophagus (in severe cases) |
Can a person have both?
Yes—some people have both EoE and acid reflux. In fact, doctors often start with acid reflux treatment first. If symptoms don’t improve, they may investigate EoE through endoscopy and biopsy.
Causes and Triggers
EoE is strongly linked to food and environmental allergens. While the exact cause is still being studied, many patients have other allergic conditions like asthma, eczema, or hay fever. The most common food triggers include:
Cow’s milk
Wheat
Soy
Eggs
Peanuts and tree nuts
Fish and shellfish
Environmental allergens like pollen or mold may also play a role, especially when symptoms worsen seasonally.
How Is EoE Diagnosed?
Because its symptoms overlap with other conditions, EoE requires specific testing for diagnosis:
Endoscopy and biopsy: A doctor uses a thin tube with a camera to look at the esophagus and collect tissue samples. High counts of eosinophils confirm the diagnosis.
Allergy testing: Sometimes used to identify potential food or environmental triggers.
Treatment Options
Treatment typically involves a combination of dietary changes, medication, and sometimes procedures to help relieve symptoms.
Dietary Therapy
Elimination diets: Removing common allergens to see which foods are triggering the inflammation.
Elemental diets: Using amino acid-based formulas to give the gut a complete break from allergens.
Reintroduction phase: Slowly adding foods back under medical supervision.
Medications
Topical steroids: Swallowed corticosteroids like fluticasone or budesonide reduce inflammation without significant absorption into the bloodstream.
Proton pump inhibitors (PPIs): May help some people with overlapping reflux symptoms or even help reduce eosinophil counts in some cases.
Esophageal Dilation
In severe cases where narrowing occurs, a doctor may gently stretch the esophagus to improve swallowing. This doesn’t treat the underlying inflammation, but it can relieve symptoms.
Living With EoE
Managing EoE is a lifelong journey, but with the right treatment plan, most people can keep symptoms under control and maintain a good quality of life. Working closely with a gastroenterologist, dietitian, and possibly an allergist can make a world of difference.
Final Thoughts
If you or a loved one has persistent swallowing difficulties, unexplained chest pain, or food getting stuck, don’t dismiss it as simple indigestion. Eosinophilic Esophagitis may look like acid reflux, but it's a unique condition that requires a targeted approach. With awareness, medical guidance, and thoughtful dietary changes, living well with EoE is absolutely possible.
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