Many people assume that frequent heartburn is simply a sign of acid reflux or gastroesophageal reflux disease (GERD). But what if the burning sensation in your chest and difficulty swallowing aren’t caused by stomach acid alone? Eosinophilic Esophagitis (EoE) is an often-overlooked condition that mimics GERD but has an entirely different underlying cause. Unlike traditional acid reflux, EoE is a chronic immune-mediated disorder where eosinophils, a type of white blood cell, accumulate in the esophagus and trigger inflammation.
Eosinophilic Esophagitis is a chronic inflammatory disease of the esophagus that results from an abnormal immune response to certain allergens or foods. In a healthy esophagus, eosinophils are rarely present. However, in EoE, these cells infiltrate the esophageal lining, causing irritation, swelling, and even scarring over time. As a result, swallowing becomes increasingly difficult, and food can feel like it’s getting stuck mid-chew.
EoE and GERD share several symptoms, making it difficult to distinguish between the two conditions. Both can cause heartburn, chest discomfort, and difficulty swallowing. However, unlike GERD, EoE does not respond well to acid-reducing medications such as proton pump inhibitors (PPIs). This leads many patients to continue experiencing symptoms despite standard reflux treatment, delaying an accurate diagnosis.
Symptoms of Eosinophilic Esophagitis

While heartburn is a common symptom of EoE, there are other telltale signs that differentiate it from acid reflux:
- Dysphagia (Difficulty Swallowing) – A hallmark symptom of EoE, characterized by the sensation that food is getting stuck in the throat or chest.
- Food Impaction – Episodes where food actually becomes lodged in the esophagus, requiring medical intervention.
- Non-Acidic Reflux Symptoms – Unlike GERD, EoE often causes irritation even in the absence of acid.
- Chronic Cough or Throat Clearing – Persistent throat irritation that is not caused by postnasal drip or infection.
- Chest Pain or Pressure – A sensation of tightness in the chest that is not relieved by antacids.
- Nausea and Regurgitation – Food or mucus may come back up without the acidic burning of GERD.
Common Triggers of Eosinophilic Esophagitis
EoE is an immune-mediated disease, meaning that specific allergens often play a role in triggering symptoms. Common culprits include:
- Food Allergens: Dairy, wheat, soy, eggs, nuts, and seafood are frequent triggers.
- Environmental Allergens: Pollen, dust mites, and pet dander can exacerbate symptoms, particularly in those with seasonal allergies.
- Acidic or Spicy Foods: While not the primary cause, these can worsen symptoms in individuals with existing esophageal inflammation.
Treatment Options for Eosinophilic Esophagitis
Managing EoE requires a combination of dietary modifications, medications, and lifestyle adjustments. The most common treatment approaches include:
- Dietary Therapy. Many individuals with EoE find relief through dietary changes. The six-food elimination diet (SFED) removes the top allergenic foods—dairy, wheat, soy, eggs, nuts, and seafood—and gradually reintroduces them to identify triggers. Some patients may also benefit from a fully elemental diet, where all nutrients come from hypoallergenic liquid formulas to allow the esophagus to heal.
- Medications
- Proton Pump Inhibitors (PPIs): While primarily used for acid reflux, PPIs may help some EoE patients by reducing esophageal inflammation.
- Topical Steroids: Swallowed corticosteroids, such as fluticasone or budesonide, help reduce inflammation without the systemic side effects of oral steroids.
- Biologic Therapies: Emerging treatments targeting specific immune pathways, such as dupilumab, are being studied for long-term EoE management.
- Esophageal Dilation. For individuals with severe esophageal narrowing, a dilation procedure may be necessary. This involves gently stretching the esophagus to improve swallowing and reduce the risk of food impaction.
Lifestyle Changes to Support Esophageal Health
While diet and medication play a significant role in managing Eosinophilic Esophagitis, daily lifestyle habits can also help reduce symptoms and prevent flare-ups. Adopting small but impactful changes can minimize esophageal irritation and improve overall digestion.
- Eating Habits to Reduce Symptoms
- Eat Slowly and Chew Thoroughly: Taking time to chew food into smaller pieces makes swallowing easier and reduces the risk of food impaction.
- Drink Plenty of Fluids During Meals: Sipping water while eating helps food pass smoothly through the esophagus.
- Avoid Large Bites: Cutting food into smaller portions can prevent it from getting stuck, especially in those with esophageal narrowing.
- Timing and Meal Size Considerations. Lying down too soon after meals can increase inflammation and irritation in the esophagus. Aim to finish eating at least three hours before bedtime. Eating large meals can overwhelm digestion and contribute to discomfort. Spacing out meals evenly throughout the day can ease symptoms.
- Managing Stress and Its Impact on EoE. Chronic stress triggers inflammation and can worsen EoE symptoms. Implementing stress-reducing techniques, such as meditation, deep breathing exercises, and yoga, may help improve immune response and digestion. To create a sleep-friendly environment:
- Elevate the Head of the Bed: Raising the head while sleeping can prevent esophageal irritation by reducing acid exposure and promoting better digestion.
- Sleep on Your Left Side: This position helps keep stomach contents from flowing back into the esophagus.
- Avoiding Environmental Triggers. Since EoE is often linked to environmental allergens, keeping dust, pet dander, and mold under control may help minimize symptoms. If pollen or other seasonal allergens trigger symptoms, working with an allergist to manage these reactions may be beneficial.
Incorporating these lifestyle changes alongside medical treatment can enhance symptom management and improve long-term esophageal health.
When to See a Doctor
Recognizing when symptoms go beyond ordinary heartburn is critical in managing Eosinophilic Esophagitis. If persistent acid reflux treatments, such as antacids or proton pump inhibitors, fail to provide relief, it may be time to consider an alternative diagnosis. Additionally, difficulty swallowing, frequent food impaction, or unexplained chest discomfort should not be ignored. These symptoms can indicate esophageal inflammation or narrowing, which can worsen over time if left untreated.
Individuals experiencing choking sensations, unexplained weight loss, or persistent nausea should seek prompt medical attention. A gastroenterologist can perform the necessary tests, such as an endoscopy and biopsy, to determine if EoE is the underlying cause. Early intervention can help prevent long-term complications such as esophageal strictures, which may require more invasive procedures to correct. Seeking medical evaluation as soon as symptoms arise allows for better disease management and improved quality of life.