Symptoms of eosinophilic esophagitis are often hard to recognize. Here’s what to look out for.

Eosinophilic esophagitis (EoE) is a chronic, inflammatory disorder of the esophagus. It occurs when immune cells called eosinophils cause inflammation in the lining of your esophagus.

Prolonged or recurring inflammation in your esophagus can cause a variety of symptoms related to eating and digestion. Symptoms of EoE can develop at any age and will vary over time and from person to person. They may be persistent, or they may come and go.

Because EoE symptoms can be difficult to recognize, diagnosis may be delayed. In this article, we take a look at the symptoms of EoE in adults and children, as well as the effects these symptoms can have on daily life.

Diagnosis of EoE in very young children is not common, possibly because the occurrence rates in this age group are low and because the symptoms can be difficult to recognize.

Symptoms of EoE in this age group are often nonspecific. The most common symptoms in young children are:

  • food refusal
  • limited food intake (less than is appropriate for the child’s age)
  • vomiting
  • irritability
  • abdominal pain

Collectively, these symptoms can lead to reduced growth, weight loss, and failure to thrive. Abdominal pain can also contribute to sleep problems.

As children get older and reach school age, parents may find it difficult to introduce new foods into their diet.

To manage their symptoms, children might develop adaptive eating behaviors such as slower eating, excessive chewing, and a preference for softer foods or liquids. Parents may need to cut their children’s food into very small pieces to help them eat.

Symptoms of EoE in older children and adolescents often more clearly indicate an esophageal issue. Possible symptoms include dysphagia (difficulty swallowing) and gagging. Food may become impacted (stuck) in the esophagus, leading to vomiting.

Food restriction and refusal may continue at this age. A child might have a limited diet and prefer soft foods or liquids. They might avoid dry or dense foods, which can be especially hard to swallow.

Children at this age might start to develop anxiety and depression related to their condition. In a web survey of people with EoE in the United States, 60% of adolescents reported experiencing stigma from their friends, family, and classmates as a result of their EoE symptoms.

EoE symptoms may also create challenges with academics at this age. More than 80% of adolescents in the survey reported that their EoE symptoms caused them to miss school or work.

In adults, swallowing difficulties and food impaction are the most common symptoms of EoE. Some people might also experience chest pain, particularly after eating.

Some people may have symptoms similar to those of gastroesophageal reflux disease (GERD) and may receive an incorrect diagnosis of GERD at first. Others might have both GERD and EoE, which can complicate the process of diagnosis.

Like adolescents with the condition, adults report high rates of anxiety, depression, and stigma related to their EoE. Mental health professionals can help people of all ages manage the emotional aspects of EoE and offer resources for coping with the symptoms.

Without proper management, chronic inflammation in EoE can lead to permanent damage to your esophagus. While this is not life threatening, it can cause serious, persistent symptoms and a variety of complications that can negatively affect quality of life.

Possible complications of EoE include:

  • narrowing of the esophagus
  • perforation or tearing of the esophagus (in rare cases)
  • malnutrition

If you have EoE, you’ll most likely need to remove certain foods from your diet to manage the symptoms. EoE is an allergic condition, and symptoms may be triggered by foods such as:

  • dairy (animal milk)
  • wheat
  • eggs
  • soy
  • nuts or legumes
  • fish and shellfish

When you live with this condition, dietary restrictions can create additional challenges. A registered dietitian can provide nutritional support to help you navigate elimination diets and help prevent complications related to nutritional deficiencies.

If narrowing of your esophagus persists even after you’ve tried dietary changes and medication, dilation may be necessary to widen your esophagus so that food can pass through.

Symptoms of EoE vary across the life span. In early childhood, symptoms are often nonspecific, and it may not be immediately clear that a digestive or allergic disorder is the cause. In older children and adults, swallowing difficulties and food impaction are more common.

Recognizing the symptoms of EoE early can allow you to get a diagnosis and start treatment sooner. If you or a loved one is experiencing symptoms that could be related to EoE, your primary care doctor can provide a referral to a gastroenterologist or an allergist for further evaluation.

You can typically manage EoE symptoms with dietary changes, medications, or a combination of the two. Dilation of your esophagus may be necessary if you’ve experienced significant esophageal narrowing.