Mayo Edge: Food not always the cause of eosinophilic esophagitis

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DEAR MAYO CLINIC: I was diagnosed with eosinophilic esophagitis a few months ago, but have had trouble with food getting stuck for years, so I've probably had it for a long time. Is it reasonable to first try elimination diets to figure out what foods trigger the reaction, or is medication usually required to treat EoE?

Because eosinophilic esophagitis, or EoE, may be the result of an allergic reaction to certain foods, taking the foods out of your diet that cause that reaction can be useful. But because it can be hard to identify the specific cause of EoE -- and because foods are not always the source of the problem -- medication is often needed to effectively control this disorder.

Eosinophils are white blood cells that regulate inflammation within your body. They also play a key role in allergic reactions. Eosinophilic esophagitis develops when a high concentration of this type of white blood cells forms in the esophagus, the muscular tube that delivers food from your mouth to your stomach. The high number of eosinophils in the esophagus is most likely in response to an allergy-causing agent, or allergen.

In many cases, people who have EoE are allergic to one or more foods. Some foods that may cause eosinophilic esophagitis include milk, eggs, wheat, soy, nuts and fish. But EoE also can be triggered by nonfood allergies. For example, inhaled allergens, such as pollen, may be the cause of EoE in some cases. Acid reflux also seems to be related to EoE, but the exact nature of this relationship is not well understood.

The hallmark symptom of EoE is food frequently becoming stuck in the esophagus. In some cases, when food becomes stuck, it causes vomiting. Rarely, severe vomiting that happens as a result of EoE can tear the esophagus and lead to serious medical complications. If left untreated, EoE can eventually result in scarring and narrowing of the esophagus, which makes symptoms worse over time.


The first step in treating EoE usually involves taking acid-blocking medications. These drugs can lower the impact of acid reflux and reduce inflammation within the esophagus. The advantage of using acid blockers first is that they can be taken long term with few side effects. The disadvantage is that only about one-third of people with EoE obtain effective relief of their symptoms using acid blockers alone.

When acid blockers are not enough, the next choice typically is a steroid medication. When treating EoE, the standard approach is to swallow the steroid preparation, rather than inhale it, so that it coats the esophagus. This method of delivering steroids to the esophagus is much less likely to cause the serious side effects that can be associated with steroids taken in pill form.

Eliminating foods from a person's diet can be a useful part of an EoE treatment plan, too. To begin, these diets usually include removing all six food types that most often cause allergic reactions -- eggs, dairy, fish, nuts, soy and wheat -- for six weeks. About 70 percent of people with EoE show symptom improvement after six weeks on this diet.

But that kind of extremely restrictive diet cannot be maintained over a long period of time. So foods are reintroduced slowly, one food type at a time. After each one, the esophagus is examined to determine if there is an allergic reaction. The entire process can take several months or longer. After going through dietary restrictions and then reintroducing certain foods, about 50 percent of people with EoE can control symptoms by eliminating one or two of the food groups from their diet, which is a diet that's much easier to stick to long term.

Most people with EoE require long-term maintenance therapy with diet and/or medication to control symptoms and to prevent significant esophageal scarring. Talk to your doctor about the best approach for your situation. -- Jeffrey Alexander, M.D., Gastroenterology, Mayo Clinic, Rochester.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. Email a question to For more information, visit

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