What are the symptoms of eosinophilic esophagitis?

Symptoms of Eosinophilic Esophagitis

The primary symptoms of eosinophilic esophagitis (EoE) vary significantly by age, with dysphagia and food impaction being the most common presentations in adults, while children typically present with feeding difficulties, vomiting, and abdominal pain. 1

Symptoms in Adults

• Dysphagia (difficulty swallowing) is the most common presenting symptom in adults, occurring in 29-100% of cases 1
• Food impaction requiring endoscopic removal occurs in 25-100% of adults with EoE and is responsible for up to 50% of all esophageal food impaction cases 1
• Chest pain is the second leading symptom in many adult cases, reported in 1-58% of patients 1
• GERD-like symptoms (heartburn, regurgitation) occur in 7-100% of adults with EoE 1
• Upper abdominal pain affects 3-25% of adult patients 1
• Nonspecific throat symptoms including globus sensation (feeling of something stuck in the throat) 1
• Diarrhea and weight loss are reported in some adult patients 1

Symptoms in Children

• Symptoms vary by age group with distinct patterns across different developmental stages 1

• Infants and toddlers (under 6 years) most commonly present with:

  • Feeding difficulties (median age 2.8 years) 1
  • Failure to thrive 1
  • Vomiting (median age 5.1 years, occurring in 8-100% of cases) 1

• School-aged children (6-12 years) typically present with:

  • Abdominal pain (median age 9.0 years, occurring in 5-68% of cases) 1
  • Vomiting 1
  • GERD-like symptoms (5-82% of cases) 1

• Adolescents most commonly present with:

  • Dysphagia (median age 11.1 years, occurring in 16-100% of cases) 1
  • Food impaction (median age 12 years, occurring in 10-50% of cases) 1

Behavioral Adaptations

• Many patients develop compensatory eating behaviors that may mask symptoms: 1
  • Eating slowly 1
  • Excessive chewing 1
  • Avoiding difficult-to-swallow foods (especially bread and meat) 1
  • Drinking large amounts of liquids with meals 1
  • Cutting food into small pieces 1

Associated Conditions

• EoE frequently occurs in patients with other atopic conditions: 1
  • Food allergies 1
  • Asthma 1
  • Eczema 1
  • Chronic rhinitis 1
  • Environmental allergies 1

Clinical Pearls and Pitfalls

• Diagnostic delay is common, with average delays of 4.6 years in adults and up to 54 months from symptom onset to diagnosis 1
• Symptoms may be unresponsive or only partially responsive to acid blockade therapy, distinguishing EoE from GERD 1
• Silent inflammation can occur - some patients may have esophageal eosinophilia without reporting symptoms, which can still lead to complications like stricture formation 1
• Age-appropriate symptom recognition is crucial, as symptoms vary significantly by age group and can be easily mistaken for other conditions 1
• Male predominance is observed with a male-to-female ratio of approximately 3:1 1