Eosinophilic esophagitis

Last reviewed: 6 Jan 2023
Last updated: 08 Jul 2022



History and exam

Key diagnostic factors

  • dysphagia
  • food avoidance and modification behaviors
More key diagnostic factors

Other diagnostic factors

  • heartburn
  • chest discomfort
  • nausea/vomiting
  • regurgitation
  • abdominal pain
  • failure to thrive
  • irritability
Other diagnostic factors

Risk factors

  • family history of EoE
  • male sex
  • atopic disease
  • children and younger adults
  • white ancestry
More risk factors

Diagnostic investigations

1st investigations to order

  • esophagogastroduodenoscopy
  • esophageal biopsy
  • CBC with differential
More 1st investigations to order

Emerging tests

  • transnasal endoscopy
  • esophageal string test
  • cytosponge
  • mucosal impedance
  • EoE diagnostic panel

Treatment algorithm


at initial diagnosis


response to initial therapy

nonresponse or relapse



Jenny Epstein, MB ChB MRCPCH PhD

Consultant Paediatric Gastroenterologist

Chelsea and Westminster Hospital




JE is a member of the advisory board for Dr Falk Pharma, manufacturer of Jorveza, a new formulation of budesonide licensed for adults with eosinophilic esophagitis (EoE), and Nurtricia for infant functional bowel disorders. She has received honoraria from Dr Falk Pharma to speak on EoE and has been sponsored by Dr Falk Pharma, Abbvie and Nutricia to attend national and international meetings. JE is a member of BSPGHAN IBD working group, medical advisor to CICRA and Coeliac UK, member of CCUK IBD working group, member of BSG EoE Guideline development group, member of NICE Guideline update committee for Crohn disease and ulcerative colitis, member of NICE Diagnostics, and sits on the NICE advisory committee for personalized treatment in Crohn disease.


Dr Jenny Epstein wishes to gratefully acknowledge Dr Evan S. Dellon, the previous contributor to this topic.


ESD is an author of a number of references cited in this topic.

Peer reviewers

David Katzka, MD

Professor of Medicine

Mayo Clinic




DK has served on advisory boards (Adare, Receptos) and received research funding (Covidien).

Alexandra Papadopoulou, MD

Honorary Professor

Chief of the Division of Gastroenterology and Hepatology

First Department of Pediatrics

University of Athens

Agia Sofia Children’s Hospital




AP has received speaker’s honorariums from Nestle and Nutricia; research grants from Biogaia/Nutricia/Abbvie; consultant’s fee from Receptos.

  • Eosinophilic esophagitis images
  • Differentials

    • Gastroesophageal reflux disease (GERD)
    • Eosinophilic gastroenteritis
    • Achalasia
    More Differentials
  • Guidelines

    • Guideline on informed consent for GI endoscopic procedures
    • Clinical guidelines for the management of eosinophilic esophagitis
    More Guidelines
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