Watts Eosinophilic Esophagitis (EoE)?

Eosinophilic Esophagitis (EoE) is a chronic immune-mediated condition that affects the esophagus — the tube that carries food from your mouth to your stomach. In people with EoE, certain triggers (often food or environmental allergens) cause a type of white blood cell called an eosinophil to build up in the lining of the esophagus. This inflammation can lead to scarring, narrowing, and difficulty swallowing.

EoE is still a relatively newly recognised condition, and many healthcare professionals are unfamiliar with it. For some people, it’s misdiagnosed for years as reflux, anxiety, or just a sore throat. But when properly diagnosed, treated and monitored, symptoms can be managed — though there’s currently no cure.

In my case, it first presented as a croaky voice and food getting stuck mid-swallow (which can be a medical emergency), but over time it also caused pain, nausea, reflux-like symptoms, and difficulty with certain food textures. Endoscopy and biopsy are required to confirm the diagnosis, and management usually involves a combination of dietary changes, allergy management, and medication.

💥 Watts Causing It?

EoE is caused by an immune response — often to allergens in food or the environment — that leads to inflammation in the esophagus. The key players are eosinophils, a type of white blood cell that normally help fight parasites but, in EoE, turn their attention to the lining of your esophagus like it’s public enemy number one.

Common triggers include:

  • Food allergens: dairy, wheat, soy, eggs, nuts, shellfish (varies person to person)
  • Environmental allergens: pollen, mould, dust mites, pet dander
  • Acid reflux and immune activation may also contribute or worsen inflammation

🌀 Watts Going Wrong?

EoE can be sneaky at first — often showing up as subtle swallowing difficulties, mild chest discomfort, or the sense that food is “slow to go down.” But over time, inflammation can lead to:

  • Food getting stuck in the esophagus (also called food impaction), which can be extremely painful and sometimes requires emergency intervention
  • Difficulty swallowing (dysphagia), especially with dry or textured foods
  • Chest pain not related to the heart
  • Nausea and reflux-like symptoms that don’t improve with standard reflux treatment
  • Weight loss or restricted eating from food avoidance due to discomfort
  • Voice changes or throat tightness, particularly with flare-ups
  • Structural changes, including narrowing (strictures) or rings forming in the esophagus

For some people, it feels like a slow build of strange symptoms. Others experience sudden, dramatic episodes where food becomes lodged mid-swallow. In either case, the impact can be physically dangerous and emotionally draining — especially if the condition isn’t recognised early.

🔍 Watts the Diagnosis Process?

EoE diagnosis typically involves a few key investigations, since its symptoms often mimic reflux, anxiety, or other gastrointestinal issues.

In my case, the process included:

  • Endoscopy – to visually inspect the esophagus for inflammation, narrowing, or small white plaques
  • Esophageal biopsy – taken during endoscopy to assess for eosinophils (a key marker of the condition)
  • Gastric biopsy – to rule out other causes like coeliac disease or helicobacter pylori
  • Gastric emptying study – to check how efficiently my stomach processes food and rule out motility issues

It was the combination of small white lesions seen during endoscopy and biopsy-confirmed eosinophil infiltration that ultimately confirmed the diagnosis. Like many conditions in the allergic/gastrointestinal overlap zone, it wasn’t immediately recognised — but once it was, the pieces began to fall into place.

🩺 Watts the Management Team?

EoE care often involves a multi-disciplinary team — especially when symptoms overlap with other allergic, gastrointestinal, and respiratory conditions. Managing it takes more than one specialty, and often requires coordination between clinicians who are willing to listen, collaborate, and adapt treatment as new challenges arise.

My management team has included:

  • GP – for day-to-day care and referrals
  • Gastroenterologist – for endoscopy, diagnosis, and long-term GI management
  • Respiratory Physician – due to overlapping treatments and triggers with asthma
  • Immunologist – for systemic allergic involvement and medication review
  • Rheumatologist – for immune system monitoring and connective tissue considerations
  • Pain Specialist – to help manage chronic GI and abdominal pain, and medication planning
  • Speech Pathologist – for assistance with swallowing and esophageal function
  • Dietitian – for identifying dietary triggers, avoiding nutritional gaps, and monitoring flare patterns
  • Psychologist – for managing food-related anxiety and supporting chronic condition coping

Getting the right care often comes down to finding the right people — and not giving up until you do.

🧩 Related Conditions

Many of the other conditions I’ve been diagnosed with are known to overlap with EoE. If you’d like to understand more about how they connect — or how they’ve shown up in my life — you can explore:

…or head over to my my blog for more stories.

You can also visit the Helpful Links page for resources and organisations I’ve found useful along the way.

Disclaimer:
I’m not a doctor — just someone with a lot of medical letters on my file and a few too many hospital wristbands. Everything shared on this site comes from my personal experience living with complex chronic conditions. It’s not medical advice, and it shouldn’t replace professional guidance. Always speak to your healthcare team before making any treatment decisions (especially if it involves sparkles, spreadsheets, or ice cream therapy).

© WattsWithPain 2025