Eosinophilic oesophagitis: what the symptoms are, why it is important to recognise it, and what to do

Do not underestimate the warning signs of a troubled oesophagus. And do discuss them with your doctor. If food gets stuck, if swallowing becomes a struggle, or if you frequently experience chest pain or a burning sensation, do not simply put it down to acid reflux, stress or slow digestion. Sometimes, behind these symptoms, there may also be a condition that is all too often diagnosed late, which can lead to more complex forms of the disease, with narrowing of the oesophagus and greater difficulty in treatment. In short: be aware of eosinophilic oesophagitis, a condition on the rise, which is often associated with asthma, allergic rhinitis, atopic dermatitis or food allergies. Unfortunately, despite these warnings, many patients still simply learn to live with their symptoms. As a result, the condition can go undetected for years. According to a survey recently conducted by experts from the Association of Italian Regional and Hospital Allergists and Immunologists (Aiito), delayed diagnosis is a problem. The case studies collected include patients who were not diagnosed until more than 10 years after the onset of symptoms. A delayed diagnosis does not merely mean having to live with symptoms for longer. Over time, uncontrolled chronic inflammation can lead to the disease progressing, resulting in narrowing of the oesophagus and functional complications that make clinical management more complex. In other words, early diagnosis does not merely serve to give the condition a name: it can alter the natural course of the disease.

In patients with eosinophilic oesophagitis, inflammation of the oesophagus can cause dysphagia, food bolus impaction and narrowing of the oesophagus, with the risk that food passes through slowly or becomes stuck, making daily meals difficult and a source of stress. Almost half of patients, including adolescents, do not achieve adequate control of the condition with the current standard of care, which is aimed at symptom management and includes dietary restrictions, oral topical corticosteroids and proton pump inhibitors. Faced with this complex condition, which therefore goes beyond simple local inflammation and involves the body’s immune response, research is yielding new developments in terms of treatment. This is demonstrated by the results of the Crossing study, presented at the United European Gastroenterology Week 2026 held in Barcelona.

Treatment with tezepelumab, administered subcutaneously every four weeks, resulted in histological remission by week 24 in 64.8 per cent of patients treated with the 210-milligram dose and in 68.9 per cent of those treated with the 420-milligram dose, compared with 3.5 per cent of patients in the placebo group. The drug also reduced, compared with baseline, the frequency and severity of dysphagia symptoms by 18.8 points with the lower dose and by 22 points with the higher dose, compared with a reduction of 14.7 points with placebo. These findings are based on the results of the Dysphagia Symptom Questionnaire (DSQ), a patient-reported outcome measure. These results were maintained up to week 52 of treatment, with histological remission achieved in 67.8 per cent (210-milligram dose) and 63.3 per cent (420 milligram dose) of patients treated with tezepelumab achieving histological remission, compared with 5.4 per cent of those who received placebo, with continued improvement in symptoms as well. Furthermore, the treatment had a positive impact on endoscopic assessments of the oesophagus.

Edoardo Vincenzo Savarino, Associate Professor of Gastroenterology and Head of the Outpatient Clinics for the Care and Treatment of Immune-Mediated Diseases, including eosinophilic diseases of the gastrointestinal tract, at the Padua University Hospital, comments as follows on the findings: ‘Eosinophilic oesophagitis is a chronic, progressive inflammatory disease of the oesophagus that can significantly impair the daily lives of those affected. In its management, symptom control is a fundamental objective, but it is important to view the disease from a broader perspective, taking into account its various components. In this regard, the results of the Crossing study are particularly significant because they show how tezepelumab, by inhibiting TSLP – a key epithelial cytokine at the origin of the inflammatory cascade – has demonstrated significant improvements across various aspects of the disease, from symptomatic to histological and endoscopic outcomes.” This is particularly important because symptom improvement does not always fully reflect control of inflammatory activity and, consequently, the prevention of disease progression towards fibrosis and oesophageal stricture. “An assessment that integrates symptomatic, histological and endoscopic aspects can therefore contribute to a more comprehensive management of the disease and its potential long-term consequences. The results of the Crossing study represent an important step forward in the evolving body of evidence on this condition and offer the prospect of a new therapeutic approach, demonstrating tezepelumab’s potential to target the various manifestations of the disease.”