Eosinophilic Esophagitis

• 75% of individuals with EoE are white males
• EoE occurs in approximately 1 in 10,000 people
• The exact cause of EoE is unknown, but it appears to be related to food allergies
• EoE is more common in patients with other allergic diseases, such as asthma
• EoE was discovered relatively recently and much remains unknown about the disease

Eosinophilic Esophagitis has only recently been identified as a disease, and many of its symptoms—particularly in children—mimic the symptoms of GERD. However, patients of different ages tend to experience different symptoms.

In children, Eosinophilic Esophagitis symptoms are usually similar to those of GERD (abdominal pain, nausea, vomiting, poor weight gain). Adolescents and adults frequently experience difficulty swallowing and food impaction.

Symptoms can include:

• Nausea
• Problems swallowing (dysphagia)
• Vomiting
• Stomach pain
• Chest pain
• Heartburn
• Loss of weight
• Food impaction

If your doctor suspects that your child has Eosinophilic Esophagitis, he or she will conduct a biopsy of the esophagus. The biopsy is usually done with a procedure called endoscopy, in which a small camera is inserted into the esophagus. Sometimes, the doctor will see rings of eosinophils (white blood cells) in the esophagus, but often it will appear normal.

After the biopsy, the tissue will be inspected for evidence of eosinophils. If an EoE diagnosis is confirmed, the doctor will likely conduct allergy testing, looking for food and environmental allergies that contribute to the patient’s EoE.

If your child is experiencing these symptoms, discuss them with your family doctor or find a pediatric gastroenterologist near you.

The most effective treatment of Eosinophilic Esophagitis involves changes to the child’s diet and nutrition. If your child is diagnosed with EoE, the doctor or medical team will work to identify which foods are causing the condition so that your child can avoid them.

The most common allergic foods include milk, eggs, nuts, beef, wheat, fish, shellfish, corn and soy, but many other foods may also be a factor in EoE.

Some children with EoE may be allergic to a single food, while others may be allergic to many foods.

Because allergy tests are often unable to determine which foods are causing your child may need to temporarily eliminate some or all normal foods from his or her diet, and gradually re-introduce them. If that’s the case, your child may need to temporarily follow an elimination diet or an elemental diet.

This video presents information about the current treatment options for Eosinophilic esophagitis (EoE). It does NOT address other types of food allergies or eosinophilic conditions beyond the esophagus.

Always consult with your health care providers when making decisions about treatment.

This type of diet removes all foods that are known to cause an allergic reaction, as well as other foods that are suspected to cause problems. The remaining foods are monitored to ensure a balanced diet.

This diet removes all sources of protein and introduces a formula made up of amino acids, fats, vitamins, minerals and sugar. Children are often placed on an elemental diet, while adults tend to supplement with other foods. In some cases tube feedings (enteral support) are necessary for growth and weight gain.

If your child improves after following an elimination or elemental diet for a few months, foods will slowly be reintroduced one at a time. Your doctor will monitor your child to make sure he or she can tolerate each food. It’s possible that your doctor will need to perform another endoscopy with biopsy to determine whether your child is responding well to the reintroduced foods.

Currently, medication does not appear to be as effective as dietary changes in the treatment of Eosinophilic Esophagitis. Certain medications, such as pump inhibitors, oral and topical corticosteroids, and leukotriene inhibitors, have been shown to have some helpful effects on patients with EoE, but dietary modifications are the primary course of treatment. The health care community is working to identify medications that may be used in the future to treat this condition.

EoE can affect a child’s quality of life in many areas, including eating, sleeping, attending school, interacting socially, and participating in age-appropriate activities. Children and teens may experience anxiety, especially around eating, food reactions, or mealtimes away from primary caregivers. Children also may experience low mood, frustration, or behavior changes related to managing their EoE and feeling different from their peers.

Managing EoE, including taking medications and following a restricted diet, can be difficult for anyone, especially a child. If your child seems to have difficulty coping with EoE treatment, the following strategies may help:

• Encourage your child to name their feelings and use words to describe their emotions to help them build emotional awareness and obtain support. For example: “I feel nervous eating lunch at school.”
• Practice active coping strategies such as diaphragmatic (abdominal) breathing, progressive muscle relaxation, or guided imagery to reduce stress and anxiety.
• Help your child practice explaining EoE and their treatment plan in simple language to peers, teachers, or other caregivers.
• Plan ahead for outings or events by choosing or preparing safe foods ahead of time. This can help children feel prepared and give them a sense of control.
• If possible, connect with other children who have EoE through local support groups or virtual communities.

Caregivers can be a great source of comfort and help children navigate living with EoE:

• Normalize and validate your child’s emotions. It is okay for them to feel anxious, frustrated, sad, or different sometimes. Encourage them to talk about their feelings with you, their doctor, or a trusted adult.
• Praise and reward your child’s effort to participate in caring for their EoE. For example, “Thank you for taking your medication right away!” or “You were so brave to eat that, even when you were feeling nervous.”
• Talk openly with your child and encourage them to problem-solve with you when there are difficulties or barriers to following their medical treatment plan. Stay in touch with your child’s medical providers and communicate any questions, concerns, or challenges you have so that they can help.
• Work with your child’s school to develop a health support plan (or Section 504 Plan) to address the likely need for your child to sometimes miss school due to doctors’ appointments or medical procedures and for them to have access to safe foods at school for lunch, snack times, and during classroom celebrations. 
• Consider whether a pediatric psychologist or other behavioral health provider familiar with pediatric chronic medical conditions would be helpful to include as part of your child’s healthcare team. Cognitive behavioral therapy (CBT) is an evidence-based treatment to reduce anxiety and support emotional adjustment in children with chronic medical conditions. 

Support for the NASPGHAN Foundation’s Eosinophilic Esophagitis Education Campaign was provided by AstraZeneca LP, Takeda Pharmaceuticals North America, Inc., Cephalon, and Meritage Pharma, Inc.

Contributors

Authors: Kelsey L. Jong, PhD, and Kelly A. O’Neil Rodriguez, PhD
Editor: Amanda Deacy, MD
July 2025