Definition
Eosinophilic Esophagitis is a chronic inflammatory condition of the esophagus characterized by a high number of eosinophils in the esophageal tissue. Eosinophils are a type of white blood cell typically associated with allergic reactions or parasitic infections.
Pathogenesis
The exact cause of Eosinophilic Esophagitis remains unclear, but it is believed to be linked to allergic reactions. Evidence suggests that factors such as certain foods, airborne allergens, and genetic predispositions may play a role.
Diagnosis
The diagnosis of Eosinophilic Esophagitis is often made using endoscopy and esophageal biopsy. Physicians look for an abundance of eosinophils in the esophageal tissue and other signs of inflammation or damage.
Treatment
Treatment for Eosinophilic Esophagitis typically involves managing allergies and addressing inflammation. This can be achieved through dietary modifications, avoiding specific allergens, and using medications such as proton pump inhibitors or corticosteroids to control inflammation. In more severe cases, immunosuppressive drugs may be necessary. Endoscopic dilation may be required in cases of significant esophageal narrowing. Early diagnosis and ongoing monitoring are key to effectively managing the condition.
Key figures: The histological criterion is at least 15 eosinophils per high power field. Biopsies are taken from several levels of the oesophagus, even when it appears endoscopically normal.
Diagnosis requires gastroscopy with biopsies. It must be distinguished from gastro-oesophageal reflux and from oesophageal motility disorders.
- Histological criterion: at least 15 eosinophils per high power field
- Biopsies are taken from several levels of the oesophagus
- The oesophagus can appear endoscopically normal
- Target of treatment is histological remission, not symptom relief alone
Frequently asked questions
Is eosinophilic esophagitis an autoimmune disease?
Not in the strict sense. The mechanism is immune mediated but allergic in type: the body overreacts to food antigens rather than attacking its own tissue. There is a strong association with atopy, meaning asthma, allergic rhinitis and eczema, but conventional allergy testing does not reliably identify the responsible food.
How is it diagnosed?
Only by gastroscopy with biopsies. Endoscopy may show rings, longitudinal furrows and whitish exudates, but the oesophagus can also appear entirely normal, which is why biopsies are always taken and from several levels. The histological criterion is at least 15 eosinophils per high power field, after excluding other causes, chiefly reflux disease.
Why does treatment continue after symptoms settle?
Because inflammation can persist silently, particularly once a patient has adapted how they eat. Uncontrolled inflammation leads over years to fibrosis and permanent stricture, which does not reverse. The aim is therefore histological remission, confirmed by repeat endoscopy and biopsies, not symptom relief alone.
Sources
- Lucendo AJ et al., Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management. https://pubmed.ncbi.nlm.nih.gov/28507746/
Content last updated: September 2026 (14/09/2026).
