Food Stuck in Your Esophagus? What is Eosinophilic Esophagitis and Why It's Increasingly Diagnosed - 2026 Guide

What is eosinophilic esophagitis?

Imagine your esophagus (the tube that carries food from your mouth to your stomach) becomes inflamed due to a constant allergic reaction. That's basically eosinophilic esophagitis. Eosinophils, a special type of white blood cells that normally defend us against parasites, accumulate in the esophagus where they shouldn't be, causing chronic inflammation.

This inflammation makes the esophagus become more rigid, narrow, and sensitive. It's like your esophagus was a flexible hose that gradually hardens and narrows, making it difficult for food to pass easily. That's why the most characteristic symptom is the sensation that food gets stuck, especially solid foods like meat or bread.

Why is it so talked about now?

30 years ago this disease practically didn't exist, or at least we weren't diagnosing it. But since then, cases have multiplied by nine. According to a global meta-analysis published in 2023, we went from 8 cases per 100,000 inhabitants in the 1990s to more than 74 cases per 100,000 inhabitants in 2022. It's one of the most spectacular increases we've seen in digestive diseases.

The epidemic increase: Why are there more and more cases?

The numbers are truly impressive. Recent studies from countries like Sweden report prevalences of up to 113 cases per 100,000 inhabitants, and in Europe and North America figures range between 34 and 42 cases per 100,000 inhabitants. The incidence (new cases each year) is between 5 and 10 per 100,000 people.

×9

Increase in cases over 25 years

From 8 to 74 cases/100k inhabitants

3:1

Male to female ratio

Affects males more

20-40

Most common age (years)

Mainly young adults

What causes this increase?

The reasons are multiple and fascinating. It's not just that we're diagnosing it better now (which is also true), but that more people are really developing the disease. The main factors include:

Genetic factors

More than 30 genetic variants have been identified associated with eosinophilic esophagitis, especially in genes affecting the esophageal barrier (such as FLG, DSG1, SPINK5) and allergic immune response. If you have first-degree relatives with the disease, your risk increases significantly.

Antibiotic use in childhood

Antibiotics at early ages alter the gut microbiome and may favor the development of allergic diseases. Early use of proton pump inhibitors has also been associated.

Cesarean birth and lack of breastfeeding

Children born by cesarean section or who didn't receive breastfeeding have a higher risk of developing allergies, including eosinophilic esophagitis.

The hygiene hypothesis

Living in excessively clean environments, with less exposure to microbes in childhood, means our immune system doesn't "train" properly and reacts exaggeratedly to food allergens. Epidemiological studies show that eosinophilic esophagitis is more common in high-income countries and low population density areas.

Symptoms: How do I know if I might have it?

The most characteristic and bothersome symptom is food impaction, that dramatic moment when food literally gets stuck in the esophagus and you can neither swallow it nor bring it back up. It's a distressing experience that usually ends in the emergency room.

Warning symptoms

• Dysphagia: Difficulty swallowing, especially solid foods like meat, bread, or rice
• Food impaction: Food completely stuck requiring urgent attention
• Chest pain: Discomfort in the chest when eating, sometimes confused with heart problems
• Regurgitation: Return of undigested food
• Heartburn: Similar to reflux, which is why it's sometimes initially confused

Many patients develop adaptive behaviors without realizing it: they eat very slowly, chew excessively, drink large amounts of liquid with each bite, avoid certain foods (especially fibrous meats or bread), or even stop eating in public for fear of a choking episode.

Typical patient profile

Eosinophilic esophagitis mainly affects young men (20-40 years) with a history of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, or food allergies. If this is your profile and you have episodes of food getting stuck, you should consult a gastroenterology specialist.

Diagnosis: Endoscopy and biopsies

The diagnosis of eosinophilic esophagitis requires an upper digestive endoscopy with biopsies. It's not enough to see the esophagus; it must be analyzed under a microscope to count eosinophils. According to the American ACG 2025 guidelines, the diagnostic criterion is finding 15 or more eosinophils per high-power field in esophageal biopsies.

What is seen on endoscopy?

Concentric rings: The esophagus looks like a "trachea" with circular rings (called "feline esophagus" or ringed esophagus)
Longitudinal furrows: White vertical lines on the esophageal mucosa
White exudates: Small white plaques that appear to be collections of eosinophils
Fragile mucosa: The esophagus tears easily during endoscopy (sign of mucosal fragility)
Stricture (stenosis): In advanced cases, the esophagus is so inflamed that it narrows

Endoscopic images of eosinophilic esophagitis showing concentric rings, longitudinal furrows and white exudates

Characteristic endoscopic findings of eosinophilic esophagitis: concentric rings (ringed esophagus), longitudinal furrows and white exudates

However, up to 10% of patients have a normal-appearing esophagus on endoscopy, which is why biopsies are essential. It's recommended to take at least 6 biopsies: 2-4 from the proximal esophagus, 2-4 from the distal esophagus.

More information about eosinophilic esophagitis

If you want to learn more about this disease, you can visit my complete page on eosinophilic esophagitis where you'll find additional information and clinical cases.

Effective treatments: We have excellent solutions

Here's the good news. Current treatments for eosinophilic esophagitis are very effective, and in recent years we've greatly improved therapeutic options. According to the latest ACG 2025 guidelines, we have three fundamental pillars: medications, diet, and endoscopic dilation.

1. Proton pump inhibitors (PPIs)

PPIs (such as omeprazole, esomeprazole, or pantoprazole) are the first treatment we try. They not only reduce stomach acid but also have direct anti-inflammatory effects on the esophagus. Approximately one-third of patients respond very well to PPIs alone.

Dose: High (omeprazole 40 mg twice daily or equivalent)
Duration: Minimum 8 weeks to evaluate response
Side effects: Headache, diarrhea, abdominal pain (generally mild)

2. Topical corticosteroids: Oral budesonide

If PPIs don't work, we move to topical corticosteroids. The most studied and effective is budesonide in orodispersible tablets (Jorveza in Europe). This formulation allows the corticosteroid to act directly on the esophagus without being absorbed into the bloodstream.

Impressive results:

• Histological remission in 80% of patients after 12 weeks
• Maintains remission in 75% at 48 weeks
• Significant improvement in symptoms and quality of life
• Effective even in cases refractory to PPIs

Excellent safety:

• Local side effects, not systemic
• Mild esophageal candidiasis in 12-15% (treatable)
• No significant adrenal suppression
• Safe for long-term use

Usual dose: 1 mg twice daily (induction), then 1 mg/day (maintenance)
How to take it: Let dissolve in mouth after meals, don't drink or eat for 30-60 minutes
Evidence: Randomized clinical trials of highest quality

3. Biologics: Dupilumab

Dupilumab is a monoclonal antibody approved by the FDA in 2022 for eosinophilic esophagitis. It blocks signals from the main allergic cytokines (IL-4 and IL-13) that cause inflammation. It's especially useful in patients who don't respond to other treatments or have multiple allergies.

Administration: Weekly subcutaneous injection
Efficacy: Significant improvement in symptoms and esophageal eosinophilia
Side effects: Injection site reactions, occasional conjunctivitis
Cost: High, reserved for selected cases

4. Endoscopic dilation for cases with stricture

When chronic inflammation has caused narrowing (stricture) of the esophagus, endoscopic dilation is a very effective solution. As a specialist in advanced endoscopy, I regularly perform this procedure with excellent results.

It consists of passing dilators (such as balloons or probes) through the endoscope to gently widen the narrow areas of the esophagus. Most patients experience immediate improvement in dysphagia. It's a safe procedure when performed by an experienced specialist.

Important: Dilation treats the symptom (narrowing) but not the cause (inflammation), so it must always be combined with medical treatment to prevent new strictures.

5. Elimination diets

Some people prefer to avoid long-term medication and opt for elimination diets. The most commonly used are:

• Six-food elimination diet: Eliminate milk, wheat, egg, soy, nuts, and fish/seafood
• Four-food diet: Eliminate milk, wheat, egg, and legumes
• Two-food diet: Eliminate only milk and wheat
• Elemental diet: Special formulas (very restrictive, impractical)

Diets work in approximately 50-70% of cases, but are difficult to maintain long-term and require nutritional supervision. Currently, most patients prefer pharmacological treatment for its convenience and efficacy.

Prognosis: Living well with eosinophilic esophagitis

The most important message

Eosinophilic esophagitis is a chronic but completely manageable disease. With current treatments, the vast majority of patients manage to live symptom-free, avoid food impaction episodes, and have an excellent quality of life.

80%

of patients in remission with oral budesonide

0%

risk of esophageal cancer

Unlike other inflammatory diseases of the digestive tract, eosinophilic esophagitis is NOT associated with an increased risk of esophageal cancer. It also doesn't affect other organs or reduce life expectancy. The main problem is quality of life due to symptoms and the risk of complications such as esophageal strictures if not properly treated.

The most important thing is to maintain regular follow-up with your gastroenterology specialist, adjust treatment according to response, and have control endoscopies to verify that inflammation is controlled. With good control, you can lead an absolutely normal life.

Conclusions: What you should remember

Eosinophilic esophagitis is an allergic disease of the esophagus that has increased spectacularly in recent decades, multiplying by 9 in just 25 years.

The main symptom is difficulty swallowing and episodes of food getting stuck, especially in young men with allergic history.

Diagnosis requires endoscopy with biopsies to confirm the presence of eosinophils in the esophagus.

Current treatments are very effective: PPIs, topical corticosteroids (oral budesonide with 80% remission), biologics (dupilumab), and endoscopic dilation if there's narrowing.

With good medical control, you can lead a completely normal life. The disease does NOT increase cancer risk.

If you have compatible symptoms or have been diagnosed with eosinophilic esophagitis, don't hesitate to consult a gastroenterology specialist. As an expert in eosinophilic esophagitis and advanced endoscopy, I can help you control the disease and improve your quality of life.

Food Stuck in Your Esophagus? What is Eosinophilic Esophagitis and Why It’s Increasingly Diagnosed – 2026 Guide | Dr. Pedro de María Pallarés

Food Stuck in Your Esophagus? What is Eosinophilic Esophagitis

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