Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Eosinophilic Esophagitis


Kristle Lee Lynch

, MD, Perelman School of Medicine at The University of Pennsylvania

Reviewed/Revised Mar 2022 | Modified Sep 2022

Eosinophilic esophagitis is an inflammatory disorder in which the wall of the esophagus becomes filled with large numbers of eosinophils, a type of white blood cell.

  • This disorder may be caused by food allergies.

  • Children may refuse to eat and lose weight, and adults may have food lodged in their esophagus and difficulty swallowing.

  • The diagnosis is based on the results of an endoscopy and biopsy, sometimes along with x-rays.

  • Treatment includes proton pump inhibitors, corticosteroids, changes in diet, and sometimes dilation of the esophagus.

Eosinophilic esophagitis can begin at any time between infancy and young adulthood. It occasionally occurs in older adults and is more common among males.

Eosinophils White Blood Cells The main components of blood include Plasma Red blood cells White blood cells Platelets read more White Blood Cells are a type of white blood cell that play an important role in the body's response to allergic reactions, asthma, and infection with parasites. Eosinophilic esophagitis may be caused by an allergic reaction to certain foods in people who have genetic risk factors. The allergic reaction causes inflammation that irritates the esophagus. If not treated, the inflammation eventually leads to chronic narrowing (stricture) of the esophagus.

Symptoms of Eosinophilic Esophagitis

Diagnosis of Eosinophilic Esophagitis

  • Endoscopy and biopsy

  • Sometimes barium swallow x-rays

Doctors suspect the diagnosis of eosinophilic esophagitis in people of any age who have other allergic disorders and difficulty swallowing solid foods. The diagnosis is also suspected in people who have symptoms of GERD that do not go away with typical treatment.

To diagnose the disorder, doctors look in the esophagus with a flexible tube (endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes... read more ). During the endoscopy, doctors take tissue samples to analyze under a microscope (called a biopsy).

Sometimes, doctors also do a barium swallow X-Ray Studies of the Digestive Tract X-rays often are used to evaluate digestive problems. Standard x-rays ( plain x-rays) can show some blockages or paralysis of the digestive tract, or abnormal air patterns in the abdominal cavity... read more . In this test, people are given barium in a liquid before x-rays are taken. The barium outlines the esophagus, making abnormalities easier to see.

Treatment of Eosinophilic Esophagitis

  • Proton pump inhibitors

  • Corticosteroids

  • Changes in diet

  • Sometimes dilation of the esophagus

Adults are given proton pump inhibitors (PPIs), which are drugs that reduce production of stomach acid and can reduce symptoms. In children, changes in diet are often effective, but PPIs are typically used if changes to the diet have not helped.

If PPIs do not help, people are given topical corticosteroids (such as fluticasone and budesonide) that are swallowed to coat the esophagus can help reduce inflammation. People may use a fluticasone inhaler and puff the drug into their mouth without inhaling and then swallow it. This way the drug coats the esophagus and does not enter the lungs. Budesonide in liquid form also can be mixed with a sugar substitute or thickener (such as cornstarch) and swallowed. People may rinse out their mouth afterwards to help avoid a fungal infection of the mouth (thrush Candidiasis (Yeast Infection) Candidiasis is infection with the yeast Candida. Candidiasis tends to occur in moist areas of the skin. This skin infection may cause rashes, scaling, itching, and swelling. Doctors examine... read more Candidiasis (Yeast Infection) ).

Doctors may instruct people to change their diet. People can follow a diet that eliminates wheat, dairy, fish/shellfish, peanuts/tree nuts, eggs, and soy (see elimination diet Diagnosis ). This diet is the most often recommended diet for eosinophilic esophagitis and is better and simpler than eliminating foods based on the results of skin and blood allergy tests. Variations of this diet, where only two or four foods are eliminated, can be tried. The elemental diet, in which people get most of their nutrition in a liquid form usually composed of amino acids, fats, sugars, vitamins, and minerals, is successful in both adults and children but is often not practical in adults.

If people have narrowing of the esophagus, doctors inflate a balloon in the esophagus during endoscopy to dilate it. Doctors often do several dilations using progressively larger balloons to prevent the esophagus from tearing.

Injection and infusion therapies that target the eosinophil pathway in the body are being studied for eosinophilic esophagitis.

Drugs Mentioned In This Article

Generic Name Select Brand Names
ArmonAir Digihaler, ARMONAIR RESPICLICK, ARNUITY ELLIPTA, BESER, ClariSpray, Cutivate, Flonase, Flonase Allergy Relief, Flonase Sensimist , Flovent, Flovent Diskus , Flovent HFA, Flovent Rotadisk, Veramyst, XHANCE
Entocort EC, Ortikos, Pulmicort, Pulmicort Flexhaler, Rhinocort, Rhinocort Aqua, Rhinocort Children's Allergy, TARPEYO, UCERIS, UCERIS Rectal
quiz link

Test your knowledge

Take a Quiz!