Specialist Allergy & Gastroenterology Service
Eosinophilic Oesophagitis (EoE)
Expert diagnosis and personalised treatment for EoE — a chronic, immune-mediated condition of the food pipe — delivered by our specialist allergy team in the UK.
| ✓ BSG 2022 Guidelines | ✓ Biologic Therapy Available | ✓ Multidisciplinary Team | ✓ Dietary & Endoscopy Support |
Understanding the Condition
What is Eosinophilic Oesophagitis?
Eosinophilic Oesophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the oesophagus (food pipe). It is characterised by an abnormal build-up of eosinophils — a type of white blood cell — in the lining of the oesophagus, causing progressive inflammation, tissue remodelling, and impaired swallowing function.
Unlike typical acid reflux, EoE is an immune-mediated, Type 2 inflammatory condition closely linked to food allergens and environmental triggers. The current estimated prevalence is approximately 34 per 100,000 people in the UK, though diagnosis rates are rising as awareness and testing methods improve. EoE is more common in males and is strongly associated with other atopic conditions including asthma, eczema, and allergic rhinitis.
Without appropriate treatment, EoE can lead to oesophageal strictures (narrowing), fibrous scarring, and severe swallowing difficulties. Early specialist involvement is essential to prevent long-term structural damage.
Key fact: Eosinophils are not normally present in the oesophagus. A finding of 15 or more eosinophils per high-powered field (HPF) on biopsy is the accepted diagnostic threshold, as set by international consensus guidelines (ACG 2025; BSG/BSPGHAN 2022).
Recognising EoE
Symptoms of Eosinophilic Oesophagitis
Symptoms vary considerably by age and may overlap with acid reflux or other oesophageal conditions, which often leads to delayed diagnosis. The following are common presentations:
Adults
| Children & Adolescents
|
⚠ Emergency: If food becomes completely stuck in the oesophagus and does not pass within two hours, this is a food bolus obstruction. Please attend your nearest Emergency Department immediately. EoE is the most common underlying cause of this condition.
Causes & Triggers
What Causes EoE?
The exact cause of EoE is multifactorial, involving genetic predisposition, immune dysregulation, and environmental exposures. Crucially, EoE is a non-IgE-mediated (delayed) food allergy, which means standard allergy skin-prick tests and specific IgE blood tests are not reliable for identifying food triggers. Diagnosis and trigger identification require endoscopic biopsy and structured dietary assessment.
The six most common food protein triggers, recognised by the British Dietetic Association and NHS specialist centres, are:
◆ Cow's Milk | ◆ Wheat & Gluten | ◆ Egg |
◆ Soya | ◆ Seafood (Fish & Shellfish) | ◆ Nuts & Seeds |
Not all six triggers are relevant to every patient. Our dietitians use structured elimination and reintroduction protocols — including the Six Food Elimination Diet (SFED) and Four Food Elimination Diet (FFED) — to identify your individual triggers safely and effectively.
The Diagnostic Pathway
How is EoE Diagnosed?
Diagnosis requires a combination of clinical assessment and endoscopic biopsy. The BSG/BSPGHAN (2022) and ACG (2025) guidelines define EoE as:
- Symptoms of oesophageal dysfunction (dysphagia, food bolus, reflux unresponsive to standard therapy)
- ≥15 eosinophils per HPF on oesophageal biopsy samples
- Exclusion of other conditions that may cause oesophageal eosinophilia
Specialist Consultation
Our allergist takes a comprehensive history including atopic background, symptom duration, dietary patterns, and previous treatments.
Upper GI Endoscopy & Biopsy
Upper gastrointestinal endoscopy (gastroscopy) with multiple oesophageal biopsies from the proximal, mid, and distal oesophagus. Typical endoscopic features include furrows, rings (trachealization), white exudates, and strictures, graded using the EREFS scoring system.
Histopathology
Biopsy samples are analysed by a specialist pathologist. Diagnosis is confirmed when peak eosinophil count reaches or exceeds 15 eosinophils/HPF, with careful exclusion of GORD, coeliac disease, and other eosinophilic gastrointestinal disorders.
Multidisciplinary Review
Confirmed cases are reviewed by our multidisciplinary team (allergist, gastroenterologist, specialist dietitian) to formulate an individualised treatment and monitoring plan.
Treatment Options
How We Treat Eosinophilic Oesophagitis
Treatment for EoE is personalised and may combine dietary, pharmacological, endoscopic, and biological approaches. Current management is guided by the ACG Clinical Guidelines (2025), BSG/BSPGHAN Guidelines (2022), and updated UpToDate protocols (May 2026).
Long-Term Care
Monitoring & Long-Term Management
EoE is a chronic, relapsing condition. Even patients who achieve remission require ongoing monitoring to detect disease recurrence, assess for oesophageal remodelling, and optimise long-term quality of life. International expert consensus guidelines (2023) recommend regular clinical review with endoscopic and histological reassessment as part of routine monitoring.
Our clinic uses validated outcome measures including the:
- EREFS (Endoscopic Reference Score) — grades mucosal features at endoscopy
- I-SEE (Index of Severity for Eosinophilic Oesophagitis) — a validated clinical severity index
- Dysphagia symptom questionnaires (DSQ) — patient-reported swallowing outcomes
- Peak eosinophil count per HPF on repeat biopsy
Treatment goals include histological remission (<15 eos/HPF), resolution of symptoms, and prevention of oesophageal fibrosis and stricture formation.
The Allergy Connection
EoE and Allergic Disease
EoE sits firmly within the spectrum of Type 2 immune-mediated conditions. Up to 70% of patients with EoE have at least one co-existing atopic condition. EoE is considered part of the “allergic march” alongside atopic dermatitis, IgE-mediated food allergy, allergic rhinitis, and asthma.
Importantly, oral food immunotherapy (OIT) — used in IgE-mediated food allergy desensitisation — is a recognised risk factor for triggering or exacerbating EoE, particularly with milk, egg, and shellfish OIT. Patients undergoing OIT at our clinic are monitored for EoE development as part of our standard safety protocols.
Our allergy specialists are trained to manage EoE both as an isolated diagnosis and as part of complex multi-system allergic disease — ensuring a joined-up approach to all aspects of your immune health.
Frequently Asked Questions
Common Questions About EoE
Is EoE the same as acid reflux (GORD)?
No. Although both conditions share symptoms such as heartburn and difficulty swallowing, they are distinct diseases with different mechanisms. EoE is immune-mediated, not acid-driven. Many patients with EoE are initially misdiagnosed with GORD and do not respond to standard acid-suppression therapy. If your reflux symptoms have not responded to PPIs, EoE should be considered and investigated with endoscopy.
Can EoE be cured?
There is currently no cure for EoE. However, the condition can be effectively managed and put into remission with the right treatment. Many patients maintain excellent quality of life with dietary modification, medication, or biologic therapy. Ongoing monitoring is required as EoE may relapse when treatment is stopped.
Will a skin-prick test or IgE blood test identify my EoE triggers?
No. EoE is a non-IgE-mediated, delayed allergic reaction. Standard allergy tests — including skin-prick tests (SPT) and specific IgE blood tests — are unreliable for identifying food triggers in EoE. Trigger identification requires a structured elimination diet with endoscopic confirmation. Our team will guide you through this process safely.
Can children have EoE?
Yes. EoE was first described in children and affects approximately 50 per 100,000 children in the UK. Symptoms in younger children often present as feeding refusal, poor growth, or vomiting rather than the swallowing difficulties more typical in adults. Our team has experience managing EoE across all age groups, including paediatric cases in collaboration with paediatric gastroenterology and dietetic colleagues.
How do I access dupilumab (Dupixent®) for EoE in the UK?
Dupilumab can be prescribed by specialist clinicians for eligible patients (adults and adolescents ≥12 years, ≥40 kg) who meet criteria based on disease severity and previous treatment history. Our team will assess your suitability and guide you through the access process, including any relevant funding or prior authorisation requirements. Private prescribing is available at our clinic.
Medical References
1. Dellon ES, Muir AB, Katzka DA et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Oesophagitis. Am J Gastroenterol. 2025;120(1):31–59.
2. Lucendo AJ, Molina-Infante J, Árias Á et al. BSG/BSPGHAN Consensus Guidelines on EoE. Gut. 2022;71(8):1459–1487.
3. Arnim UV, Biedermann L, Aceves SS et al. Monitoring Patients with EoE in Routine Clinical Practice — International Expert Recommendations. Clin Gastroenterol Hepatol. 2023;21(10):2526–2533.
4. Lim WK et al. Dupilumab normalises the EoE disease transcriptome. J Allergy Clin Immunol. 2026 Apr 22 [Online ahead of print]. doi:10.1016/j.jaci.2026.01.033.
5. Hoang TT et al. Real-world outcomes of dupilumab for treatment of EoE. J Can Assoc Gastroenterol. 2026. doi:10.1093/jcag/gwaf042.191.
6. Regeneron/Sanofi. Dupixent demonstrates improved oesophageal function in EoE Phase 4 Trial. DDW 2026 late-breaking oral presentation. May 2026.
7. British Dietetic Association — Food Allergy Specialist Group (FASG). Six Food Elimination Diet for EoE patient guidance. 2019 (updated).
8. Guts UK. Eosinophilic Diseases patient information. Published April 2025; reviewed April 2028.
Concerned You or Your Child May Have EoE?
Our specialist allergy team offers prompt assessment, expert diagnosis, and access to the latest treatments including biologic therapy. Referrals accepted from GPs and self-referrals welcome.
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This page is intended for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. UK Allergy Clinic | www.ukallergy.com | Page last reviewed June 2026.