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Eosinophilic Esophagitis (Adult)

Chronic immune-mediated esophageal inflammation with eosinophil predominance presenting with dysphagia and food impaction in adults; managed with the six-food elimination diet, PPI, swallowed topical steroids, dupilumab, and esophageal dilation.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Eosinophilic Esophagitis (Adult)?

Eosinophilic esophagitis (EoE) is a chronic, type 2 cytokine-driven immune-mediated disease characterized by esophageal symptoms and biopsy-proven eosinophilic inflammation (≥15 eosinophils/high-power field) without alternative cause. Adults typically present with dysphagia to solids and food impaction; many have a history of atopy (asthma, allergic rhinitis, eczema, food allergies).

Pathogenesis involves Th2 cytokines IL-4, IL-5, and IL-13 driving eosinophil recruitment, mast cell activation, basal zone hyperplasia, and progressive subepithelial fibrosis leading to remodeling, narrowing, and strictures. Endoscopic findings include rings (trachealization), furrows, exudates, edema, and strictures, summarized by the EoE Endoscopic Reference Score (EREFS); pH monitoring and esophageal manometry may complement assessment.

Diagnosis requires endoscopy with at least 6 biopsies from proximal and distal esophagus on or off PPI; histology must show ≥15 eosinophils per HPF after excluding other causes such as GERD, achalasia, infection, drug reaction, or eosinophilic gastroenteritis. Treatment goals are symptom remission, histologic remission (<15 eosinophils/HPF), and endoscopic improvement, achieved with diet, drugs, or dilation alone or in combination, with long-term maintenance to prevent fibrostenotic progression.

Symptoms

Dysphagia to solid foods, especially meat, bread, rice
Food impaction requiring endoscopic disimpaction
Slow eating, chewing thoroughly, drinking water with meals (adaptive behavior)
Chest pain, retrosternal discomfort, heartburn unresponsive to PPI
Regurgitation and rare vomiting
History of atopy: asthma, allergic rhinitis, eczema, food allergies
Symptoms episodic and progressive over years if untreated

Risk Factors

Personal or family history of atopy and food allergy
Male sex (3:1 male predominance), white ancestry
Onset typically 20-40 years
Specific genetic variants (CAPN14, TSLP, calpain pathway)
Early-life environmental factors (cesarean birth, antibiotic exposure, formula feeding)
Concurrent eosinophilic gastrointestinal disorders
Aeroallergen seasonality with disease flare

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent dysphagia or food impaction in adults
  • Heartburn unresponsive to standard PPI therapy
  • History of atopy with new-onset esophageal symptoms
  • Need for repeated endoscopic dilations or recurrent food bolus impactions
  • Symptom relapse after initial therapy or maintenance failure
  • Considering dietary therapy with allergist or dietitian guidance
  • Severe symptoms or poor quality of life despite topical steroid

Treatment Methods

01
Empirical elimination diet (six-food: dairy, wheat, egg, soy, nuts, fish/shellfish; or step-up four/two-food) with sequential reintroduction guided by endoscopy
02
Proton pump inhibitors at high dose (omeprazole 20-40 mg twice daily) for 8-12 weeks; assess histologic response
03
Swallowed topical corticosteroids: budesonide oral suspension (orodispersible tablet 1 mg twice daily) or fluticasone metered-dose inhaler swallowed (440-880 mcg twice daily) with rinse-and-spit to reduce candidiasis
04
Dupilumab (anti-IL-4Rα biologic) for adults and adolescents with refractory or severe disease per regulatory approval
05
Endoscopic esophageal dilation for fixed strictures or rings causing dysphagia, performed cautiously to avoid mucosal tear
06
Maintenance therapy long-term to prevent relapse and fibrostenotic progression; periodic endoscopy with biopsy to assess histology
07
Multidisciplinary care with gastroenterology, allergy/immunology, dietitian, and patient education on chewing, food avoidance, and emergency management of impaction

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.