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Oesophagitis eosinophilica
Biopsies decide, not blood — and the quiet eating tricks are the real clue.
Also known as: EoE · food gets stuck · swallowing trouble in children · allergic oesophagitis · heartburn not responding to acid blockers · gagging while eating
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Eosinophilic oesophagitis is an allergy-driven inflammation of the gullet. It has become markedly more common over the past twenty years, yet on average it is recognised years after the first symptoms — because those symptoms look entirely different at different ages. Small children eat slowly, refuse solid food, gag or vomit and gain weight poorly. School-age children complain of belly or chest pain and nausea. Teenagers and adults report that mouthfuls get stuck. The telling part is the quiet adaptations: eating very slowly, washing every bite down with water, avoiding meat and bread, always being last to finish. These habits are taken for personality and therefore never mentioned. Blood tests help little: eosinophils in blood are often normal, and a normal IgE rules nothing out. Only endoscopy with biopsies decides — and that holds even when the gullet looks perfectly normal, because the inflammation is often visible only under the microscope.
Several samples from upper and lower gullet — even if it looks normal. Without samples the diagnosis is not made.
How long a meal takes, what is avoided, how often water is sipped — three sentences that often trigger more than any lab value.
A proportion of people respond — that is now accepted treatment, not merely a test.
Not sprayed into the lungs but swallowed, so it acts on the lining. Rinse the mouth afterwards.
Cow’s milk is by far the commonest trigger. Leaving out a single food is manageable day to day and already gives many people the answer.
Symptoms often improve faster than the inflammation. Without a check it stays open whether it has really gone.
Three routes have been studied and work differently: acid blockers help about one in three; swallowed steroid preparations that stick in the oesophagus instead of running into the stomach work in most; and the elimination diet works precisely when the trigger food is found. No route cures lastingly — after stopping, the inflammation returns. A dilatation helps against the narrowing, not against the inflammation.
The diagnosis needs at least fifteen eosinophils per field in the tissue sample — and samples from several levels, because the distribution is patchy. About four to six in ten thousand people are affected, men three times as often. A treatment trial is judged after eight to twelve weeks with a repeat scope, not by how the person feels — complaints and findings often diverge. In about half an allergy is also found.
Meat and dry bread first. If nothing goes down any more and saliva comes back up, that is an emergency — do not wait.
Eating very slowly, washing everything down with water, avoiding meat and bread, finishing last. This has to be asked about directly.
No sticking, but gagging, vomiting, food refusal and poor weight gain.
If reflux is treated and the trouble persists, this condition belongs on the list.
Hay fever, asthma, atopic eczema or a known food allergy, in the person or in the family.
Raised in some, entirely normal in many. A normal value rules nothing out.
This condition does not run through classic immediate-type allergy. Positive results therefore say little about what actually has to be left out.
Anyone avoiding meat for months because it sticks often has empty stores.
With chronic inflammatory and autoimmune pictures low levels are common — partly because the illness itself lowers the level, partly because less time is spent outdoors. Whether correcting it changes the course is being studied; for bone and muscle it is worthwhile regardless.
They give rise to messengers that tend to end inflammatory reactions rather than fuel them. Oily sea fish twice a week is the simplest route; capsules are an option but replace no treatment.
Needed for steering the defences and for the healing of tissue. A lack is more common with chronic diarrhoea, little meat and pulses, and under cortisone.
Part of the body’s own protection against oxidative stress. The need is covered by Brazil nuts, fish, eggs and offal — more is not better here, and high doses over long periods are not harmless.
Not studied for this condition. What works is the six-food elimination diet or a medicine — with a check by endoscopy, because the complaints do not match the findings.
The gap that opens: milk is the first item in any elimination diet here and at the same time the most important calcium source. 1000 mg a day stays the target — from fortified drinks, calcium-rich water or a supplement.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.
Swallowed cortisone — as a melting tablet or from an asthma inhaler, but swallowed rather than inhaled — acts locally in the gullet. That is one of the few places where the way it is used makes the whole treatment.
Some of those affected respond to acid blockers without reflux being present — they apparently work here through another route. This makes them a treatment trial and not proof of heartburn.
Milk, wheat, egg, soy, nuts and fish are left out for 6 weeks, then reintroduced one at a time with follow-up. Milk alone is the trigger for many — so one or two groups are often the starting point rather than six.
A narrowed oesophagus passes large bites poorly. Small bites with fluid lower the risk of something getting stuck.
Here the elimination diet is a recognised treatment, on a par with medication. Milk alone is the trigger for many — so one group rather than six is often the starting point.