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Home / Allergy and immune care / Immune conditions
For clinicians

Eosinophilic esophagitis (EoE): what it is and how it is treated

A chronic immune disease of the esophagus, how guidelines define it, and the treatments they recommend.

2 minute read, written for clinicians3 sources, each checked word for wordLibrary checked October 18, 2026

Hands slicing red and yellow peppers on a wooden board

This is the clinician view. It keeps every sentence of the plain guide and adds, for each section, the study design and citations of its sources. Every added sentence is cited and checked like the rest. Back to plain language.

In short

  • EoE is a chronic immune-mediated disease of the esophagus.E2Good1
  • It is diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field on biopsy, after other causes are considered.E2Good2
  • Guideline treatments include proton pump inhibitors, topical steroids, diet elimination, a biologic and esophageal dilation.E2Good1

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades meanUnderlined words open a definition

What is EoE?

The 2025 American College of Gastroenterology guideline describes EoE as a chronic immune-mediated disease of the esophagus. It is diagnosed with symptoms of esophageal dysfunction and a build-up of eosinophils, a type of white blood cell, in the esophagus.E2Good1

The evidence in this section (1 source)
SourceDesignGradeCitations (NIH iCite)
1 Dellon ES, Am J Gastroenterol, 2025GuidelineE2Good172 (RCR 59.93)

How is it diagnosed?

International consensus criteria call for symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (about 60 per square millimeter) on esophageal biopsy. They also call for a full assessment of other conditions that could cause or add to the eosinophils.E2Good2

Because proton pump inhibitors reduce esophageal eosinophils in children and adults, the updated criteria removed the earlier requirement to try one before diagnosis.E2Good2

The evidence in this section (1 source)
SourceDesignGradeCitations (NIH iCite)
2 Dellon ES, Gastroenterology, 2018Consensus statementE2Good962 (RCR 49.51)

How is it treated?

The guideline recommends proton pump inhibitors, topical steroids, empiric diet elimination, a biologic and esophageal dilation. Feeding therapy is added for children with food aversion or feeding problems.E2Good1

In a phase 3 trial in people 12 and older, weekly dupilumab injections improved biopsy results and eased symptoms compared with placebo.E1Strong3

The guideline recommends monitoring with symptoms, endoscopy and biopsy to check the response to treatment and to follow people over time on maintenance therapy.E2Good1

The evidence in this section (2 sources)
SourceDesignGradeCitations (NIH iCite)
1 Dellon ES, Am J Gastroenterol, 2025GuidelineE2Good172 (RCR 59.93)
3 Dellon ES, N Engl J Med, 2022Randomized trialE1StrongNot tracked

Questions you might bring to your clinician

  1. Which treatment fits best here, and how will the response be checked?
  2. Is a diet elimination approach worth trying, and with whose help?
  3. How often are follow-up endoscopies needed?
  4. Could other conditions be adding to the eosinophils?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, whose specialty is anesthesia, is pending; an allergist has not yet reviewed it. This line changes when each review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. Dellon ES, Am J Gastroenterol, 2025. E2Good GuidelinePMID 39745304; DOI 10.14309/ajg.0000000000003194; cited 172 times, relative citation ratio 59.93 (NIH iCite, 2026-10-16)
    The words this page rests on
    Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus. It is diagnosed in the setting of symptoms of esophageal dysfunction and an eosinophilic predominant infiltrate in the esophagus.
    Proton pump inhibitors, topical steroids, empiric diet elimination, a biologic, and esophageal dilation are all recommended treatments; feeding therapy is used adjunctively in children with food aversion or feeding dysfunction.
    Monitoring with clinical, endoscopic, and histologic assessments is recommended to assess for treatment response and follow patients over time with maintenance therapy.
  2. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Dellon ES, Gastroenterology, 2018. E2Good Consensus statementPMID 30009819; DOI 10.1053/j.gastro.2018.07.009; cited 962 times, relative citation ratio 49.51 (NIH iCite, 2026-10-16)
    The words this page rests on
    EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia.
    Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement.
  3. Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. Dellon ES, N Engl J Med, 2022. E1Strong Randomized trialPMID 36546624
    The words this page rests on
    Among patients with eosinophilic esophagitis, subcutaneous dupilumab administered weekly improved histologic outcomes and alleviated symptoms of the disease.