Eosinophilic Oesophagitis (EoE)
An allergy-type inflammation of the food pipe (oesophagus). Food sticks on the way down, sometimes completely. It’s increasingly common, often missed for years, and very treatable.
Quick answer: Eosinophilic oesophagitis (EoE) is an allergic-type inflammation of the food pipe, often triggered by foods such as milk and wheat. The main symptom is food sticking when swallowing. It’s diagnosed by biopsies at endoscopy. Treatment options are a proton pump inhibitor, swallowed budesonide, removing trigger foods, or dupilumab, and most people get good control.
How common. About 1 in 2,500 people in Western countries, and rising. It’s about three times more common in males, can start at any age, and is most often diagnosed in children and adults aged 20 to 50. Most people also have asthma, eczema, hay fever or food allergies.
Causes. A type of white blood cell, the eosinophil, builds up in the lining of the oesophagus, mostly in response to foods (commonly milk, wheat, egg and soy) and possibly pollens. Over years, the inflammation can stiffen and narrow the food pipe.
Symptoms. In adults: food sticking or slow to go down (dysphagia), especially meat and bread, chest pain or heartburn that doesn’t settle with usual treatment, and food getting completely stuck (food bolus impaction). Many people eat slowly, chew a lot, cut food small and drink lots with meals without realising they’re compensating. Children may have vomiting, tummy pain, feeding refusal or poor growth.
How it’s diagnosed. With an endoscopy (a camera into the food pipe) and at least 6 biopsies from different levels. The BSG 2022 guideline defines EoE as symptoms of oesophageal dysfunction plus at least 15 eosinophils per high-power field on biopsy, with other causes ruled out. The oesophagus may look ringed, furrowed or narrowed, but can look normal, which is why biopsies matter. Skin prick and blood allergy tests don’t reliably identify EoE food triggers.
Treatment
Three first-line options work well: a PPI, swallowed budesonide, or a diet. Pick with your specialist; all need a repeat endoscopy to check they’re working.
- Option · PrescriptionProton pump inhibitor (PPI)Such as omeprazole or esomeprazole, usually twice a day for 8 to 12 weeks, then the lowest dose that works.
- Works
- About half of people get biopsy remission
- Access
- PBS-subsidised; cheap
- Watch for
- Generally well tolerated. More in our PPIs guide.
- Option · PrescriptionSwallowed corticosteroid: budesonide orodispersible tabletA tablet that dissolves on the tongue and coats the oesophagus. Swallowed budesonide or fluticasone from an inhaler or as a slurry are older alternatives.
- Works
- In the EOS-2 trial, 58% of adults were in complete remission after 6 weeks (none on placebo), rising to 85% after 12 weeks
- Access
- In Australia, the tablet has been PBS-listed for adults since May 2022
- Watch for
- Oral thrush in about 1 in 20, easily treated. Don’t eat or drink for 30 minutes after.
- Option · DietitianFood elimination dietRemove the commonest triggers (milk alone, or 2, 4 or 6 food groups), then reintroduce one at a time with repeat endoscopies to find yours. Best with a dietitian.
- Works
- In a 2023 trial, removing milk alone led to remission in 34% vs 40% with a six-food diet; it avoids medicines once triggers are known
- Access
- Dietitian (GP chronic disease plan may help)
- Watch for
- Restrictive diets are hard to keep up and can affect nutrition.
- Step up · SpecialistDupilumabA biologic injection for people whose EoE doesn’t respond to other treatment.
- Works
- In a 2022 trial, 60% reached biopsy remission vs 5% on placebo at 24 weeks
- Access
- Specialist only; access and cost vary by country
- Watch for
- Injection-site reactions, eye irritation.
- Add-on · SpecialistOesophageal dilationGently stretching a narrowed oesophagus during endoscopy.
- Works
- Quickly relieves swallowing trouble from narrowing, but doesn’t treat the inflammation
- Access
- Gastroenterologist
- Watch for
- Chest pain afterwards is common; tears are rare.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- IgG food sensitivity testsDon’t identify EoE triggers and aren’t recommended by allergy societies.
- Doing nothing because symptoms are ’manageable’Untreated EoE can slowly narrow the oesophagus, even if you’ve learned to eat around it.
Living with it
- Chew well, take smaller bites and keep water handy, but don’t let coping tricks replace treatment.
- Keep taking maintenance treatment; EoE usually comes back when it stops.
- Check with your specialist before restarting foods you’ve removed.
- Know what to do if food gets stuck (see below).
See your GP if
- Food sticks when you swallow, even occasionally
- Heartburn or reflux hasn’t settled with treatment
- You’ve had food stuck before and needed it removed
- A child with allergies has vomiting, feeding problems or poor growth
Get urgent help if food is stuck and you can’t swallow your saliva, or you have chest pain, trouble breathing or vomit blood: call 000 (Australia) or your local emergency number or go to an emergency department. Don’t try to force it down with more food.
Outlook. EoE is a long-term condition, but treatment controls it well for most people and lowers the risk of narrowing and food impaction. It doesn’t increase the risk of oesophageal cancer.
Common questions
What does eosinophilic esophagitis feel like?
Most often food, especially meat or bread, feels like it sticks in the chest or throat. Some people have heartburn or chest pain that doesn’t settle with reflux treatment. Children may vomit or refuse food.
What foods trigger eosinophilic esophagitis?
Milk is the most common trigger, then wheat, egg and soy; nuts, fish and shellfish less often. Triggers are found by removing foods and checking biopsies, not by allergy tests.
Is EoE the same as reflux?
No. Both can cause heartburn, but EoE is an allergic-type inflammation, diagnosed by biopsy. It often doesn’t respond to standard reflux doses.
Can eosinophilic esophagitis be cured?
Not cured, but well controlled. It usually comes back if treatment stops, so most people stay on a PPI, swallowed steroid or diet long term.
Is eosinophilic esophagitis an autoimmune disease?
No. It’s an allergic-type (type 2) inflammation driven by foods and environmental allergens, not the body attacking itself.
What happens if EoE is left untreated?
Ongoing inflammation can scar and narrow the oesophagus over years, making food impaction more likely.
How is EoE diagnosed?
With an endoscopy and several biopsies. At least 15 eosinophils per high-power field, with symptoms and other causes ruled out, confirms it.
Evidence and more information
- Dhar et al, BSG 2022: Guidelines on the diagnosis and management of eosinophilic oesophagitis
- Lucendo et al, Gastroenterology 2019: Budesonide orodispersible tablets for EoE (EOS-2)
- Kliewer et al, Lancet Gastroenterol Hepatol 2023: One-food versus six-food elimination diet in adults with EoE
- Dellon et al, NEJM 2022: Dupilumab in adults and adolescents with EoE
- ASCIA: Eosinophilic oesophagitis
- ASCIA: Jorveza is PBS listed for treatment of EoE
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