GERD and Eosinophilic Esophagitis

Learn How to Tell the Difference Between the Two

Many of the symptoms experienced by people with gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) overlap. While both conditions have the same symptoms, the treatments are different. If you are being unsuccessfully treated for GERD another diagnosis to have your doctor consider is eosinophilic esophagitis.

Discussing chest pain with doctor.
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Shared Symptoms Between GERD and EoE

The following is a list of the shared symptoms between GERD and eosinophilic esophagitis:

  • nausea
  • vomiting
  • abdominal pain
  • chest pain
  • difficulty sleeping
  • difficulty swallowing (dysphagia)

Diagnosing GERD vs EoE

The differences between GERD and EoE become apparent by looking at the etiology (cause or origin) of the disorders. While GERD is associated with a reflux problem (acid coming up the esophagus), the cause is not well understood in eosinophilic esophagitis.

Research, however, shows that allergies and the immune system's responses are possible causes of eosinophilic esophagitis. While once considered rare, EoE is growing in prevalence. This is likely due to an increased understanding of this disorder and availability of testing.

Both GERD and EoE have involvement of eosinophils in the esophagus. Eosinophils are a type of white blood cell. The difference between GERD and EoE can't really be diagnosed until a biopsy is performed. A small amount of tissue from the esophagus is taken during a procedure called an EGD. Using a high-powered field on a microscope, a count of 15 eosinophils throughout the esophagus is consistent with eosinophilic esophagitis. A count of less than 10 eosinophils at the distal (lower portion) of the esophagus is consistent with GERD.

Difference in Treatment for GERD and EoE

One of the treatments of choice in GERD is the use of proton pump inhibitors like pantoprozole, omeprazole, lansoprazole, or dexlansoprazole. These medications, however, do not prevent the symptoms in eosinophilic esophagitis; the pH (acid-base balance) of the stomach is normal in these cases, unlike the pH associated with GERD.

There are not currently any medications approved for treating eosinophilic esophagitis. However, your physician may try using topical steroids as well as dietary management of the symptoms. There are several types of diets that are thought to reduce allergen exposure to the esophagus. The diets differ according to how aggressively foods are removed from your diet.

It is thought that by eliminating foods that you are even mildly allergic to you will experience a reduction in symptoms. It is always important to involve your doctor when making major dietary changes, as malnutrition can occur if you eliminate important proteins, vitamins, or minerals from your diet. In order to minimize your risk for malnutrition, consider finding food substitutes that are similar in nutrition.

Important Takeaway

Most GERD-like symptoms are indeed caused by GERD. There may be some people with GERD that are unresponsive to therapy who actually have eosinophilic esophagitis. EoE often has a delayed diagnosis as it is not as common as GERD and the symptoms overlap. Eosinophilic esophagitis is not fatal and is not known to cause cancer. However, malnutrition is a major concern due to difficulty swallowing or treatment with eliminating foods from your diet.

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Article Sources
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  1. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of GER & GERD. Updated November 2014.

  2. American Academy of Allergy Asthma and Immunology. Eosinophilic Esophagitis (EoE). Updated February 24, 2020.

  3. Kia L, Hirano I. Distinguishing GERD from eosinophilic oesophagitis: concepts and controversies. Nat Rev Gastroenterol Hepatol. 2015;12(7):379-386. doi:10.1038/nrgastro.2015.75

  4. Molina-infante J, Ferrando-lamana L, Mateos-rodríguez JM, Pérez-gallardo B, Prieto-bermejo AB. Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies: a review of the literature. World J Gastroenterol. 2008;14(9):1463-6. doi:10.3748/wjg.14.1463

  5. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for GER & GERD. Updated November 2014.

  6. Syed A, Maradey-romero C, Fass R. The relationship between eosinophilic esophagitis and esophageal cancer. Dis Esophagus. 2017;30(7):1-5. doi:10.1093/dote/dox050

Additional Reading
  • EoE. American Partnership for Eosinophilic Disorder. .

  • Nonevski, I.T., Downs-Kelly, E. & Falk, G.W. (2008). Eosinophilic esophagitis: An increasingly recognized cause of dysphagia, food impaction, and refractory heartburn. Clevland Clinical Journal of Medicine. Vol. 75(9): pp 623-633.