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Health condition · Clinically reviewed

Eosinophilic oesophagitis, the allergic disease that hides behind reflux and dysphagia.

A chronic, atopic oesophageal disease - now a leading cause of adult food impaction. A clear ladder of endoscopy, PPI, topical steroids, targeted diet and biologics changes outcomes.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK gastroenterologist before publication.

  • 02

    Sourced from guidance

    Checked against UEG, AGA and BSG standards for eosinophilic oesophagitis.

  • 03

    Current for 2026

    Reflects NICE-approved Jorveza and dupilumab pathways for adult EoE.

Key facts

EoE at a glance.

The essentials, in plain English - what it is, who gets it, how it is diagnosed and how it is treated in the UK today.

  • What it is

    A chronic, immune-mediated oesophageal disease with Th2, IL-13 and IL-5 driven eosinophilic infiltration and dysfunction.

  • How common

    Prevalence around 1 in 2500 in the UK and rising rapidly - now a major cause of adult dysphagia and food impaction.

  • Who it affects

    Men outnumber women 3 to 1. Peaks are 20 to 40 in adults and 5 to 10 in children, with strong atopic association.

  • What triggers it

    Food allergens - especially milk, wheat, egg, soy, nuts and seafood - alongside genetic (TSLP, CAPN14) and environmental factors.

  • How it is diagnosed

    Upper GI endoscopy with proximal and distal biopsies showing 15 or more eosinophils per high-power field.

  • How it is treated

    A stepped ladder - high-dose PPI, swallowed topical steroids (Jorveza), targeted diets, dupilumab and dilatation.

Why this guide matters

An allergic disease that hides in plain sight.

EoE is often mistaken for reflux for years before diagnosis. The three points below shape everything else on this page.

  • Biopsies make the diagnosis

    The mucosa can look normal. Proximal and distal biopsies at endoscopy - 15 or more eosinophils per high-power field - are what confirm EoE.

  • A stepped ladder works

    High-dose PPI first for many, then swallowed topical steroids (Jorveza or fluticasone), targeted diet, dupilumab and dilatation as needed.

  • Maintenance is the point

    EoE is chronic. Stopping treatment usually brings inflammation back, so ongoing therapy and serial endoscopy are the plan.

How the diagnosis is made

From first symptoms to a confirmed diagnosis.

The steps a UK gastroenterologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and atopic review

    Dysphagia, food impaction, chest pain, reflux-like symptoms - plus a careful atopy history covering asthma, rhinitis, eczema and food allergy.

  2. 02

    Assessing

    Distinguish from GORD

    Overlap is common. Reflux, achalasia, strictures and oesophageal cancer all sit in the differential and are ruled in or out with endoscopy.

  3. 03

    Assessing

    Symptom impact and red flags

    Food bolus impaction is an emergency and needs urgent endoscopy. Any weight loss, bleeding or new dysphagia is a red flag.

  4. 04

    Confirming

    Upper GI endoscopy (OGD)

    Look for linear furrows, trachealisation, white plaques or exudate, crepe-paper mucosa and strictures. See our gastroscopy guide.

  5. 05

    Confirming

    Proximal and distal biopsies

    15 or more eosinophils per high-power field in the proximal and distal oesophagus is diagnostic - the essential step, even when the mucosa looks normal.

  6. 06

    Confirming

    Allergy work-up when relevant

    Skin prick tests, specific IgE and, selectively, atopy patch tests - always with a specialist allergy team when planning targeted elimination.

  7. 07

    Planning

    MDT plan and follow-up

    Gastroenterology, allergy, dietitian and specialist EoE clinic set a maintenance plan with serial endoscopy and biopsies.

Typical timeline: a first clinic visit to a confirmed diagnosis in weeks, not months.

Symptoms

What EoE actually feels like.

Dysphagia and impaction in adults, feeding difficulty and failure to thrive in children - and the features that mean it is time to escalate.

  • Dysphagia in adults

    Difficulty swallowing solids - the dominant adult symptom and the reason most people first present. See our dysphagia guide.

  • Food bolus impaction

    Food stuck in the oesophagus - a medical emergency needing urgent endoscopy and retrieval.

  • Chest pain and heartburn

    Retrosternal pain or reflux-like symptoms that can masquerade as GORD, sometimes for years before diagnosis.

  • Feeding difficulty in children

    Refusal, slow feeds, prolonged mealtimes and failure to thrive - the classic paediatric picture.

  • Vomiting and abdominal pain

    Non-specific but common in children - often mistaken for reflux disease and worth revisiting if PPIs do not settle it.

  • Atopic comorbidities

    Asthma, allergic rhinitis and eczema sit alongside EoE in most patients - a strong pointer to the diagnosis.

  • Food allergy overlap

    Around 50 to 75 per cent of people with EoE have another IgE-mediated food allergy - milk, wheat, egg, soy, nuts or seafood.

  • Red flag - impaction

    Any suspected food bolus obstruction needs the emergency department and gastroenterology on-call - do not wait it out at home.

Treatment

How EoE is treated in the UK.

High-dose PPI, swallowed topical steroids (Jorveza), targeted diets, dupilumab and endoscopic dilatation - matched to the individual.

  • High-dose PPI

    Omeprazole 40 mg twice daily for 8 to 12 weeks - first-line for many and effective in 30 to 50 per cent of adults.

  • Jorveza (budesonide ODT)

    A NICE-approved orally disintegrating budesonide tablet - the first UK-licensed specific therapy for adult EoE. See our Jorveza EoE clinic.

  • Swallowed fluticasone

    Fluticasone MDI puffed into the mouth and swallowed - a well-evidenced alternative topical steroid regimen.

  • Budesonide slurry

    A viscous liquid budesonide preparation - useful when tablets do not suit or coverage of the oesophagus needs boosting.

  • Six-food elimination

    Removing milk, wheat, egg, soy, nut and seafood with staged reintroduction and repeat endoscopy - dietitian-led.

  • Step-up diet plans

    Four-food, two-food (milk and wheat) or one-food (milk) elimination diets - less restrictive, increasingly used.

  • Dupilumab (Dupixent)

    An anti-IL-4Ra biologic - MHRA and NICE-approved for adult EoE since 2023 based on the LIBERTY-EoE-TREET trial. See our dupilumab clinic.

  • Oesophageal dilatation

    For fixed strictures and narrow oesophagus - safe with modern technique and often combined with medical therapy. See our dilatation page.

What this guide is based on

The sources behind every claim on this page.

UK and international specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gastroenterologist knows your history and endoscopy findings and can tell you which parts apply to you. If in doubt, get seen.

  • United European Gastroenterology (UEG). Guidelines on eosinophilic oesophagitis.

  • American Gastroenterological Association (AGA). Clinical practice guidelines on EoE.

  • British Society of Gastroenterology (BSG). Position statements and guidance on EoE.

  • NICE. Technology appraisals for budesonide orodispersible tablets (Jorveza) and dupilumab in EoE.

Red flags

When EoE needs urgent attention.

Most EoE is managed in specialist outpatients. These are the situations that need same-day or urgent input.

  • Food bolus impaction

    Complete obstruction with drooling or inability to swallow saliva is an emergency - urgent endoscopy for retrieval, never blind pushing.

  • Oesophageal perforation

    Severe chest pain, subcutaneous emphysema or shock after impaction or dilatation - Boerhaave or iatrogenic rupture needs immediate surgical review.

  • Rapid weight loss

    Unintentional weight loss with dysphagia always needs prompt endoscopy to exclude oesophageal cancer as well as EoE.

  • GI bleeding

    Haematemesis or melaena is not typical of EoE and needs urgent endoscopy to look for another cause.

  • Failure to thrive in children

    Faltering growth or persistent food refusal warrants paediatric gastroenterology and dietetic input without delay.

  • Refractory symptoms

    Ongoing dysphagia or impaction despite PPI and topical steroids needs escalation - biologics, dilatation or a change of dietary strategy.

  • Stricture on endoscopy

    A narrow oesophagus, Schatzki ring or fibrotic remodelling deserves specialist dilatation alongside medical therapy.

  • PPI non-response

    A negative PPI trial does not exclude EoE - repeat endoscopy with biopsies drives the next step.

  • New severe atopy

    Sudden severe allergic disease alongside dysphagia should trigger an allergy referral in parallel with gastroenterology.

Living with it

A chronic condition, with a real plan.

Four things that make the biggest difference day to day - planning for the long haul, working with a dietitian, knowing the impaction plan and keeping up with follow-up endoscopy.

A quiet reminder

Symptoms are not always a reliable guide.

People often feel better long before the inflammation has settled - and inflammation can grumble on quietly. Repeat endoscopy is how we know.

  1. 01 Chronic

    Plan for the long haul

    EoE is chronic. Symptoms and inflammation return when treatment stops, so a maintenance plan matters more than a quick fix.

  2. 02 Diet

    Work with a specialist dietitian

    Elimination and reintroduction diets only work with expert support - not something to try alone from an internet list.

  3. 03 Emergency

    Know the impaction plan

    If food gets stuck and you cannot swallow saliva, go to A&E. Do not try to force it down or induce vomiting.

  4. 04 Follow-up

    Serial endoscopy is normal

    Repeat OGD with biopsies is how we know a treatment is working - symptoms alone are not a reliable guide.

Frequently asked

Everything we get asked about EoE.

Quick answers on biopsies, PPI, Jorveza, diet, dupilumab and food impaction.

  • What is eosinophilic oesophagitis?

    A chronic, immune-mediated disease of the oesophagus driven by Th2 inflammation and eosinophilic infiltration. It causes dysphagia, food impaction and reflux-like symptoms in adults, and feeding difficulty, vomiting and failure to thrive in children. It is diagnosed on upper GI endoscopy with biopsies showing 15 or more eosinophils per high-power field.

  • How is EoE different from acid reflux (GORD)?

    GORD and EoE overlap and can coexist. Both cause heartburn and chest discomfort, but EoE typically causes more dysphagia and food impaction, is strongly linked to atopy, and shows characteristic endoscopic features - furrows, rings, white plaques - with dense eosinophilic infiltration on biopsy. Updated guidelines consider PPI-responsive oesophageal eosinophilia the same disease as EoE.

  • Why do biopsies matter even if the oesophagus looks normal?

    The mucosa can look completely normal in EoE. The diagnosis is made on tissue - proximal and distal biopsies showing 15 or more eosinophils per high-power field. Without biopsies, EoE is regularly missed for years.

  • What is Jorveza and who is it for?

    Jorveza is an orally disintegrating budesonide tablet - a swallowed topical steroid designed for the oesophagus. It has been NICE-approved since 2019 as the first UK-licensed specific therapy for adult EoE, and is used for induction and maintenance under specialist care.

  • When is dupilumab used?

    Dupilumab (Dupixent) is a subcutaneous biologic that blocks IL-4Ra and dampens Th2 inflammation. It is MHRA and NICE-approved for adult EoE based on the LIBERTY-EoE-TREET trial and is commissioned through specialist services for people who have not responded to topical steroids or dietary therapy.

  • What should I do if food gets stuck?

    A food bolus that will not pass and stops you swallowing saliva is a medical emergency - go straight to A&E. The gastroenterology team will retrieve it endoscopically. Do not push food down forcefully or induce vomiting because of the risk of oesophageal rupture (Boerhaave syndrome).

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