Eosinophilic Oesophagitis (EoE) is a chronic immune-mediated condition in which a type of white blood cell called an eosinophil accumulates in the oesophagus – the tube connecting the mouth to the stomach.
This build-up causes inflammation and, over time, can lead to scarring and narrowing (strictures) of the oesophagus, making swallowing difficult and painful.
EoE is triggered by an abnormal immune response to food or environmental allergens. It is distinct from other oesophageal conditions such as gastro-oesophageal reflux disease (GORD), though the two can occur together and share some symptoms. EoE is a chronic condition requiring long-term management.
How common is Eosinophilic Oesophagitis?
EoE has become increasingly recognised over recent decades. It is estimated to affect approximately 1 in 1,000 to 1 in 2,000 Australians, with prevalence rising globally – likely reflecting both increased awareness and genuinely increasing rates.
EoE can occur at any age but is most commonly diagnosed in children, adolescents, and young to middle-aged adults. It affects men approximately three times more often than women. EoE is more common in people with other allergic conditions such as asthma, eczema, and hay fever.
Symptoms vary by age.
In adults and older children, the most common symptoms are:
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- Difficulty swallowing (dysphagia) – food feels like it is sticking in the throat or chest
- Food impaction – food becoming lodged in the oesophagus, requiring medical intervention to clear
- Chest pain or discomfort unrelated to the heart
- Heartburn or reflux-like symptoms that do not respond well to acid-reducing medication
- Regurgitation of undigested food
In younger children, symptoms may include:
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- Feeding difficulties, refusal to eat, or prolonged mealtimes
- Vomiting or regurgitation
- Failure to thrive or poor weight gain
- Abdominal pain
EoE is caused by an abnormal immune response, most commonly to food allergens.
The exact mechanism is not fully understood, but contributing factors include:
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- Food allergens – the most common triggers are cow's milk, wheat, egg, soy, nuts, and seafood. Exposure to these foods provokes an eosinophilic inflammatory response in the oesophagus
- Environmental allergens – pollen and other aeroallergens can also trigger EoE, explaining the seasonal variation in symptoms some people experience
- Genetics – EoE tends to run in families, and several genetic variants are associated with susceptibility
- Atopic background – having other allergic conditions (asthma, eczema, allergic rhinitis) significantly increases risk, suggesting a shared immune dysregulation
Diagnosis requires both clinical assessment and tissue confirmation. EoE cannot be diagnosed by symptoms alone:
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- Clinical history – symptoms, dietary history, and personal or family history of allergic conditions
- Endoscopy (gastroscopy) – a flexible camera is passed into the oesophagus under sedation. Characteristic findings include oesophageal rings, furrows, white plaques, and a narrowed oesophagus
- Biopsy – tissue samples are taken from the oesophagus during endoscopy. The diagnosis requires finding 15 or more eosinophils per high-power field on microscopy
- Allergy assessment – skin prick testing, specific IgE testing, or patch testing may help identify food triggers
Diagnosis and management is typically led by a gastroenterologist in conjunction with an allergist/clinical immunologist, particularly in children.
Treatment aims to reduce oesophageal inflammation, relieve symptoms, and prevent stricture formation.
The main approaches are dietary modification, medication, and in some cases endoscopic dilation.
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- Dietary therapy — eliminating trigger foods is highly effective. Approaches include empiric elimination diets (removing common allergens such as milk, wheat, and egg) or targeted elimination based on allergy testing. A dietitian experienced in EoE is an essential part of the care team.
- Swallowed topical corticosteroids coat the oesophageal lining to reduce inflammation. Budesonide (as a viscous slurry or orally disintegrating tablet) and fluticasone (swallowed rather than inhaled) are the main options used in Australia.
- Dupilumab (Dupixent) is an IL-4/IL-13 inhibitor and the first biologic specifically approved for EoE, used in adults with moderate-to-severe disease or inadequate response to other treatments.
- Endoscopic dilation mechanically widens the oesophagus in patients who have developed strictures or significant narrowing. It does not treat underlying inflammation and is used alongside other therapies.
The following specialty medications are available at Ace, a specialty pharmacy for Eosinophilic Oesophagitis.
Note: Swallowed topical corticosteroids (budesonide viscous slurry or fluticasone) are commonly used for EoE but are general/compounded preparations not included in this specialty medications table. Speak with your Ace pharmacist about availability.
With Ace, you’ll benefit from:
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- Expert Support — Our dedicated team of health concierges is always available to answer your questions, provide guidance, and help you navigate your condition with confidence.
- Specialty Medication — We offer a wide range of specialty medications and support services, designed specifically for those living with chronic illnesses. Whether you’re looking for help managing a specific condition, or simply need access to the medications you need, we’ve got you covered.
- A Wide Range of Conditions — From diabetes to heart disease, and everything in between, we help manage a variety of special condition
Take control of your health and well-being, and start your journey to better health with Ace today.
EoE and Allergy Support
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- EoE Australasia – Australian and New Zealand support and information for EoE patients and families
- ASCIA (Australasian Society of Clinical Immunology and Allergy) – clinical information on allergic and immune conditions including EoE
- Crohn's & Colitis Australia – EoE is not IBD but CCFA provides some GI condition resources
Clinical Resources
