Diagnosing Eosinophilic Esophagitis (EoE): Tests, Early Diagnosis, and Your Doctors
Health ConditionsDigestive Health

Diagnosing Eosinophilic Esophagitis (EoE): Tests, Early Diagnosis, and Your Doctors

Diagnosing Eosinophilic Esophagitis (EoE): Tests, Early Diagnosis, and Your Doctors
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Updated on April 25, 2025
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Eosinophilic esophagitis (EoE), a chronic disease that causes inflammation and damage to the esophagus, can be tricky to diagnose accurately. This is due to the fact that some of the symptoms of EoE and gastroesophageal reflux disease (GERD) can overlap. Diagnosis may be further delayed due to a general lack of awareness of the condition.

The earlier you are diagnosed, the sooner you can start treatment for EoE and stave off complications.

Diagnostic Tests for Eosinophilic Esophagitis (EoE)

An upper endoscopy is the only way to diagnose EoE. An endoscopy is a procedure in which a flexible tube with a light and camera on the end is passed through your mouth into your esophagus to see if your esophagus is inflamed.

In EoE, the esophagus may look red, swollen, or narrowed, with white, bumpy patches or an accordion-like appearance.

Visual inspection may not be enough to diagnose EoE, as up to 10 percent of people with EoE have an esophagus that appears normal.

In these cases, a biopsy can help to confirm the diagnosis. During an endoscopy, your doctor will remove small samples of tissue from your esophagus. A pathologist analyzes the tissue samples under a microscope to determine if EoE is present.

If a biopsy shows that there are 15 or more eosinophils in a specific section of the sample, this indicates probable EoE.

Doctors often repeat biopsies throughout the diagnostic process and over the course of the disease to track the condition of the esophagus and see if treatment is helping.

If your doctor suspects that you may have EoE based on your symptoms, they will recommend tests to detect inflammation and increased amounts of eosinophils, the type of white blood cells that give the disease its name.

 Additionally, they may recommend tests to rule out other conditions or determine EoE triggers.

Other tests that may be useful in providing more information about the cause of your EoE include:

Allergy Tests

Many people with EoE also have allergic rhinitis or food allergies. Allergic reactions to food are a main cause of EoE symptoms. Sometimes, doctors recommend allergy testing to get more information about what’s triggering your symptoms, but these tests aren’t always reliable.

Blood tests, skin prick tests, and food patch tests are typically used to diagnose allergies. However, these tests often fail to expose food sensitivities in EoE because reactions can be delayed or develop over days. Additionally, EoE flare-ups are generally caused by different immune system mechanisms than those that are found in traditional food allergies.

Sometimes environmental allergens, such as pollen, dust mites, or mold play a role in EoE. Allergy testing for these common culprits may be done as part of your evaluation.

Elimination Diet

Doctors may recommend an elimination diet to try to pinpoint which foods are causing your symptoms. This strategy involves eliminating certain foods or drinks from your diet for several weeks and then adding them back one at a time.

If your symptoms return when you reintroduce foods, your doctor may perform follow-up biopsies to see if eosinophils have returned. This can help uncover which foods are causing a reaction.

Once the problematic foods are removed, symptoms usually improve in a few weeks.

 However, foods that trigger EoE can change over time, which can further complicate the diagnostic process.

Tests to Rule Out Other Conditions

Other diseases can cause eosinophils to build up in the esophagus. Some of these include:

Sometimes, tests may be needed to rule out these conditions.

 GERD, for example usually presents with fewer eosinophils in the esophagus than EoE, but experts haven’t yet clarified exactly how many eosinophils define severe reflux (stomach acid entering the esophagus) versus EoE.

What Happens After an EoE Diagnosis?

After you get an EoE diagnosis, you and your doctor will decide on the best treatment plan. Because EoE is such a complex disease, you may work with specialists in addition to your primary care physician, such as:

  • Allergist or Immunologist This type of specialist can help you determine if your reactions are due to certain foods or environmental triggers.
  • Gastroenterologist A gastroenterologist specializes in diseases of the digestive tract. They can perform tests such as endoscopies and provide you with specialized care for EoE.
  • Registered Dietitian (RD) An RD can help you create an appropriate diet plan for improving your symptoms.

The American Partnership for Eosinophilic Disorders (APFED) provides a specialist finder feature that helps you locate medical professionals who treat eosinophilic diseases. You can search for a provider by specialty and location.

The American Academy of Allergy Asthma and Immunology and the American College of Gastroenterology supply similar resources for helping you find a qualified medical professional.

Coping with an EoE diagnosis can be challenging, and you may want to seek support outside the medical community. APFED’s online support community lets patients, caregivers, and family members connect and share information.

The Takeaway

  • EoE can be difficult to diagnose and may mimic other, more common conditions.
  • An endoscopy and biopsy are often a key part of the diagnostic process. You may need repeat biopsies to determine if treatment has been effective.
  • Following an elimination diet can help identify foods that trigger EoE symptoms.

Additional reporting by Jenna Fletcher.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Dellon ES. Challenges in Differentiating and Diagnosing Gastroesophageal Reflux Disease vs Eosinophilic Esophagitis. Gastroenterology & Hepatology. January 2024.
  2. Muir AB et al. Eosinophilic esophagitis: early diagnosis is the key. Clinical and Experimental Gastroenterology. August 2019.
  3. Eosinophilic Esophagitis. American Academy of Allergy Asthma & Immunology. May 2023.
  4. Abe Y et al. Endoscopic Diagnosis of Eosinophilic Esophagitis: Basics and Recent Advances. Diagnostics. December 16, 2022.
  5. Eosinophilic Esophagitis (EoE). Kids with Food Allergies. May 2023.
  6. Food Elimination Diet for Eosinophilic Esophagitis (EoE). University of Wisconsin School of Medicine and Public Health.
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