Young and trouble swallowing? You should read this!

Steak was the first thing to go….followed by broccoli.

Mr JB is in his twenties.

Fit, well, with no family history worth writing down. Just hay fever….the sort that turns June into lots of tissues and nasal sprays. Plus some mild asthma.

He also had trouble swallowing.

For two years he managed it by himself. Water with every mouthful. Chewing until his jaw ached. Twice, food had stuck fast and he had left the table to bring it back up in a restaurant toilet.

He told nobody. He assumed he was just a slow eater.

He was NOT.

I booked him for a gastroscopy. The oesophagus showed mild ridging, faint rings running across the lining like the inside of a windpipe. Subtle. Easy to miss if you are not looking for it.

The biopsies came back loaded with a white blood cell that has no business being there at all.

Eosinophilic oesophagitis.

We started treatment. Within a few weeks he was ordering steak again.

Let me explain more!

The eosinophil is a white blood cell built for allergy and parasites.

It normally belongs in your blood…and occasionally the gut lining.

It does NOT belong in your oesophagus, which is normally the one stretch of the digestive tract with no eosinophils in it at all.

In eosinophilic oesophagitis (EoE for short) they turn up anyway.

Something swallowed, almost always a food protein, sets off an allergic-type immune response in the lining. Eosinophils flood in. The wall swells, thickens, inflames.

Over years, that inflammation lays down scar tissue, and a tube that should be soft and stretchy turns stiff and narrow. Doctors call this remodelling. It is why catching this early matters so much.

And it is not rare. European estimates have climbed from around 15 cases per 100,000 people before 2007 to roughly 63 per 100,000 since 2017 [1].

Three patterns show up again and again.

Young. Most adult diagnoses land somewhere between the twenties and the forties.

Male. Men are affected about three times as often as women [1].

Atopic. This is the big one. EoE travels with the allergic family….asthma, eczema, hay fever, food allergy.

Mr JB’s hay fever was not a coincidence…

There were other clues. A white European background. A family history of EoE. Coeliac disease.