What is EoE?

  • Eosinophilic oesophagitis (EoE) is a chronic disease in the oesophagus which is triggered by an immune system response to food antigens.
  • This response leads to difficulty in swallowing food (oesophageal disorder) and inflammation caused by eosinophils, which are leukocytes that shouldn't normally be in the oesophagus. This makes the oesophagus narrower and it is harder for food to get through it.
  • This disease occurs in both children and adults and is associated with a range of symptoms due to the oesophagus not working as it should.
  • At the microscopic scale, there is a higher than usual build-up of eosinophils (a type of white blood cell) on the oesophagus's walls.

What are the symptoms?

Symptoms may vary depending on the age at diagnosis. As the disease is still largely unknown, many patients develop adaptive mechanisms to make swallowing food easier. They often drink a lot of liquid during meals, cut food into very small pieces, chew for a long time before swallowing, eat slowly, reject certain foods because they are more difficult to swallow, etc.

It is important to be vigilant, and when in doubt the best thing to do is to see a specialist to confirm or rule out the presence of the disease. The earlier it’s diagnosed, the sooner its progression can be stopped and quality of life improved.

Refusing food. Chest and stomach pain Dysphagia
Delayed growth Refusing food Food gets stuck in the oesophagus.
Vomiting Vomiting Vomiting
Regurgitation Hypersalivation Chest pain
*From 5 years of age Difficulty swallowing (dysphagia)*  
  Food may get stuck in the oesophagus*  

How is it diagnosed?

  • At present the only way to make an effective diagnosis is by endoscopy which involves collecting multiple biopsies (at least six are required, two in each segment of the oesophagus: cervical, thoracic and abdominal)
  • A patient is considered to have eosinophilic oesophagitis when there are more than 15 eosinophils per high magnification field in the biopsy specimens.

How is it treated?

  • As it is a chronic disease, treatment is designed to keep it in remission (no symptoms and no eosinophils).
  • Monitoring and preventive treatment is extremely important even when the symptoms are mild.
  • Several types of treatment are currently available and all of them should be performed under medical supervision:
    • Drugs such as:
      • Proton pump inhibitors (PPIs).
      • Swallowed corticosteroids.
    • Diets:
      • Empirical elimination aimed at finding the food or foods which trigger the disease.
      • Elemental in some cases.
      • At the moment diet is the only treatment to target the cause of the disease.
      • The most common allergens triggering the disease are milk, gluten, egg, pulses, nuts and fish and shellfish
  • Non-treatment or progression of the disease can lead to stenosis and fibrosis which will need to be tackled by dilatation.

How many people are affected?

Its prevalence is currently estimated at 43-56 cases per 100,000 people (figures for Europe and the United States*).

* Source: Molina-Infante J, Gonzalez-Cordero PL, Ferreira-Nossa HC, Mata-Romero P, Lucendo AJ, Arias A. Rising incidence and prevalence of adult eosinophilic esophagitis in midwestern Spain (2007-2016). United Eur Gastroenterol J. 2017; DOI: 205064061770591