Eosinophilic oesophagitis (EoE) is a long-term allergic type of inflammation of the oesophagus (food pipe). A type of white blood cell called the eosinophil builds up in the lining. Over time the inflammation can make the food pipe stiff and narrow.
It is more common in men and in people with asthma, eczema, hay fever or food allergies. Many adults live with it for years, chewing carefully and drinking water with every mouthful, before it is diagnosed.
Common symptoms in adults
- Difficulty swallowing solid food, especially meat, rice or bread
- Food getting stuck in the chest, sometimes needing to be brought back up
- Heartburn or chest pain that does not settle with reflux medicine
- Eating slowly, cutting food into small pieces, or avoiding certain foods
Diagnosis
EoE is diagnosed with a gastroscopy and biopsies. Several small samples are taken from different levels of the food pipe, because the inflammation can be patchy. The food pipe may show rings, lines or white spots, but it can also look normal, so biopsies are needed even when it looks healthy. Other causes such as acid reflux are considered at the same time.
Treatment
- Acid-reducing medicine (a proton pump inhibitor) at a higher dose, which settles the inflammation in some people
- Swallowed steroid medicine, which coats the food pipe and acts mainly on its lining
- Diet changes, such as removing milk or wheat for a period with a dietitian's help, to find a food trigger
- Stretching (dilation) of a narrowed food pipe during gastroscopy, to make swallowing easier
- Biologic injections for selected people when other treatments are not enough
A repeat gastroscopy with biopsies is usually done after treatment, because symptoms alone do not show whether the inflammation has settled. EoE is a long-term condition, so ongoing treatment is often needed.
General information only. Reviewed by Dr Chia Chung King, 2026-11-07. Book a consultation.