Eosinophilic esophagitis (EOE) is a medical condition that more dental professionals should know about because it involves the oropharyngeal area and a patient’s diet and lifestyle. Sadly, some dental professionals and much of the public have never heard of EOE, and the symptoms are sometimes mistaken for something else. This article will shed light on this disease in hopes that readers might start identifying anyone they know who needs to be tested for EOE. In addition, this article includes resources for referring patients who may be experiencing symptoms of EOE.
What is eosinophilic esophagitis (EOE)?
EOE is a chronic autoimmune response in which the esophagus becomes inflamed as white blood cells, known as eosinophils, collect as a response to the type of food that a person is eating. Everyone has eosinophils in their body, and in normal situations, they help protect our immune system. With EOE, eosinophils do the opposite and attack the body. Over time, this collection of eosinophils causes the esophagus to respond with inflammation, and then shrink or narrow off. The narrowing, depending on its severity, can cause a variety of reactions such as difficulty eating or esophageal tearing.1–3
In the past, EOE was often diagnosed in children as they expanded their dietary palate through infancy and early childhood.2 Scientists and the medical community are unsure why, but cases of EOE are increasing. Now, more adults are being diagnosed—currently 34 out of every 100,000 people have EOE, with Caucasian men age 30–40 most diagnosed.2–3
Recognizing the symptoms and risk factors of EOE
Common symptoms of EOE include vomiting, reflux, difficulty swallowing (dysphagia), abdominal pain, chest pain, and food impaction in the esophagus. In infants and toddlers, EOE can also cause weight loss, failure to thrive, and malnutrition, in addition to the symptoms listed above.1–3
Patients diagnosed with EOE often have common risk factors. Patients with reactions to everyday, common allergens are at an increased risk of developing EOE. Genetics, food allergies, pollen, mold, dust mites, animal dander, asthma, allergic rhinitis, eczema, and atopic dermatitis are all conditions commonly seen in patients who develop EOE.1,3 The six most common food allergens are eggs, soy, wheat, dairy, seafood/shellfish, and peanuts/tree nuts.3 Research shows that a patient’s location and the time of the year can influence EOE, and patients in colder climates are more susceptible.2 In addition, when environmental allergies are high, such as in the spring and fall, patients are at increased risk for EOE symptoms.2
EOE diagnosis and treatment
The primary concern with EOE is that eosinophils can cause scar tissue after being turned on by the allergen in the patient’s esophagus. The scar tissue, with enough time, can cause the esophagus to shrink, narrowing so much that a patient can have food stuck in their throat. In this case, the patient will be seen in a medical office where they’ll receive oxygen and a gastrologist will remove the food. Often, a patient who is unaware or undiagnosed eats foods that bring on the eosinophil reaction. In turn, their body responds by trying to protect itself, but causing natural distress. If enough eosinophils collect and cause esophageal shrinkage, a patient’s esophagus could eventually rupture, requiring major surgery and a feeding tube.1–3
EOE is treated in various ways. A gastrologist will diagnose EOE, and then, depending on the patient’s symptoms and lifestyle, may first encourage the patient to keep a food journal to identify the frequency of flare-up reactions. A flare-up reaction is when a patient feels some of the symptoms of EOE, often on a milder scare. Nutritional counseling helps patients become more aware of their eating and how their body responds to stimuli. In addition, the doctor may recommend the patient review their medical and family history to see if they have EOE risk factors. Once EOE is suspected, the gastrologist may order a blood test to identify which food allergens are causing the disease. Next, the gastrologist may perform an upper endoscopy to examine a patient’s esophagus for eosinophils.1-3
EOE and dental professionals
Dental professionals need to know about EOE for various reasons. When performing an intraoral cancer screening, a patient may report symptoms such as dysphagia or feeling like their throat is restricted after eating. A patient may also disclose that they have common risk factors such as food allergies or asthma on their medical history and may not know how to link their EOE symptoms. Dental professionals should offer support to any patient expressing possible EOE symptoms. Refer them to their medical doctor for a checkup and encourage them to report their symptoms. A dental professional could also aid in nutritional counseling to see if the patient reports consuming heavy amounts of foods that trigger EOE.
EOE is a chronic, autoimmune response to allergens. The disease is becoming more common in our patient population for idiopathic reasons. Dental patients can mistake EOE for heartburn, acid reflux, dysphagia, or just feeling ill. Dental professionals cannot diagnose or treat EOE, but they can help direct patients to a medical professional who can. Learning about EOE is a way all dental professionals can grow to be broader, more knowledgeable practitioners.
Editor's note: This article appeared in the August/September 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subsciption. Sign up here.
References
- Wagner E. Could you have eosinophilic esophagitis? What you need to know. Myhealthteam. 29, 2022. https://eoe.myhealthteam.com/resources/Could-You-Have-Eosinophilic-Esophagitis-What-You-Need-To-Know
- Eosinophilic esophagitis. Mayo Clinic. July 2, 2024. https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/symptoms-causes/syc-20372197
- Eosinophilic esophagitis. Cleveland Clinic. Last reviewed May 29, 2024. https://my.clevelandclinic.org/health/diseases/14321-eosinophilic-esophagitis
