Eosinophilic oesophagitis (EoE)

What is eosinophilic oesophagitis?

Eosinophilic oesophagitis (EoE; you may also see the US spelling esophagitis) is a chronic immune, allergy-pattern inflammation of the oesophagus. Eosinophils in the lining can cause dysphagia, fibrosis, strictures, and food bolus obstruction (FBO). It follows a delayed food-protein allergy pattern. Do not start an elimination diet before a gastroenterology work-up.

There is no dedicated NHS.uk condition page. Guts UK and EOS Network are the UK patient homes. Commissioning of one licensed medicine is set out in NICE TA708 (budesonide orodispersible tablet, Jorveza). Guts UK estimates prevalence at 34 per 100,000 (almost 1 in 3,000).

Related eosinophilic gut diseases exist and are rarer. They are not covered on this page.

How it is diagnosed

BSG/BSPGHAN 2022: symptoms of oesophageal dysfunction plus a peak of at least 15 eosinophils per 0.3 mm² on biopsy, with at least six biopsies from multiple levels.

• Allergy tests (IgE blood tests or skin-prick tests) do not diagnose EoE and are not a trigger-finding shortcut.
• The older label PPI-REE (PPI-responsive oesophageal eosinophilia) is retired. A response to a PPI does not exclude EoE.
• A PPI is a treatment, not a diagnostic gate.
• PPIs can mask the diagnosis. Guts UK says that if EoE is the question, people are ideally off a PPI for 3 weeks before the index endoscopy. Do not stop a prescribed PPI on your own.

Common symptoms

• Solid-food dysphagia — food feels slow or stuck
• Food sticking
• Food bolus obstruction — an emergency
• Coping habits: slow eating, extra chewing, lots of fluid with meals
• In children: feeding difficulty, vomiting, poor growth

This page cannot tell you whether your swallowing problem is EoE, reflux, or something else.

Common patterns

• More common in males.
• Incidence rises in adolescence and early adulthood.
• Atopy (asthma, eczema, allergic rhinitis) is common but not required.
• Untreated disease can progress to fibrostenotic narrowing. Dilatation treats the narrowing; it is not a substitute for disease-modifying treatment.

A UK series (Hossain, Frontline Gastroenterology, 2025; n = 2,300) reported a median 3.6 years to diagnosis (IQR 0.5–8.8), 67.7% male, median age 38. EOS Network is the UK charity for people living with EoE.

Overlapping conditions

GORD and EoE are not mutually exclusive and can coexist (BSG, GRADE high). Heartburn does not rule EoE in or out. Histamine intolerance and MCAS sit in an atopy-overlap conversation; they are not the same diagnosis as EoE. Candida has been a historical mislabel for oesophageal eosinophils — it is not a cause of EoE. IBS is not the main cousin of this condition.

Research and commissioning

BSG/BSPGHAN 2022 lists high-dose PPI, swallowed topical steroids, and a dietitian-led step-up elimination (1-food, then 2-food, then 4-food MEWS, then 6-food), with repeat endoscopy at 8–12 weeks. An elemental diet is reserved for after other options fail. Do not start a six-food elimination from the internet.

Guts UK states that topical steroids help symptoms in up to 85 in 100 people within 12 weeks, and that PPIs reduce inflammation on biopsy in up to half.

NICE TA708 recommends Jorveza (budesonide orodispersible tablet) for inducing remission in adults. The TA did not recommend it for maintenance. Local ICB practice may vary — this page does not promise maintenance funding.

ACG 2025 no longer requires a failed PPI trial before an EoE diagnosis — PPIs are positioned as treatment, not as a test that rules EoE out. That matches the BSG position that PPI-REE is retired and a PPI response does not exclude EoE.

Approaches people discuss

EoE is diagnosed on endoscopy with biopsies. Do not start a six-food elimination, and do not stop a prescribed PPI, from this page.

• Established Specialist gastroenterology care. Do not self-start elimination, and do not stop a prescribed PPI before endoscopy without the specialist. Sources: BSG/BSPGHAN 2022; Guts UK; EOS Network.
• Established High-dose PPI as treatment (not as a test that "rules out" EoE). The older PPI-REE label is retired. Sources: BSG/BSPGHAN 2022; Guts UK; ACG 2025.
• Established Swallowed topical steroid: Jorveza for adults under NICE TA708 (induction of remission; the TA did not recommend maintenance); swallowed fluticasone (off-label); budesonide slurry. Thrush is a known topical-steroid side effect. Local ICB practice may vary — this page does not promise maintenance funding. Sources: NICE TA708; Guts UK; BSG/BSPGHAN 2022.
• Established Dietitian-led step-up diet after the diagnosis is made (1-food → 2-food → 4-food MEWS → 6-food), with repeat endoscopy as the guideline describes. Dilatation of a stricture with ongoing disease-modifying therapy — dilatation alone is not a substitute. Sources: BSG/BSPGHAN 2022; Guts UK.
• Limited Dupilumab and other biologics, unless a live NICE technology appraisal recommends them for EoE. Without that TA, they are not presented here as routine NHS care. Sources: NICE technology appraisal status.

Community insights

Anecdotal themes:

• People describe years of “just eat slower” or “it’s anxiety” before anyone takes biopsies — matching the long UK median delay.
• Coping with extra chewing and lots of fluid is everyday life for many, and it is not a treatment.
• Food bolus obstruction is the event that finally gets an emergency endoscopy for some.
• EOS Network is the charity people are pointed to when NHS.uk has no dedicated leaflet.