By: Kelsey Adair, MS, with Katsura Aoyama, PhD

About 12 years ago, my dad was enjoying a fajita dinner with family friends when he suddenly began to choke, or so we thought. Within seconds, panic swept through the room. My father, the picture of health up until this point, was terrified. I watched as my dad grabbed at his chest, his face turning red, and severe hiccups began to wrack his body. After 30 minutes, he finally felt the food “go down.” At first, this incident was written off as a one-time mishap. Fajitas, after all, can be tough to chew and swallow in general. But similar episodes grew more frequent, often accompanied by chest pain, facial erythema, severe globus sensations, and persistent hiccups. “Some attacks lasted for a couple of hours,” he recalled, “and trying to push the food down with liquid only made it worse."

Despite repeated visits to multiple physicians, the initial diagnosis was gastroesophageal reflux disease (GERD). Antacids and proton pump inhibitors were prescribed, yet the symptoms and the feeling of choking persisted. Attempts to better understand what was happening to him led to multiple emergency room visits, modified barium swallow studies, and rounds of anti-inflammatory medication that yielded no definitive relief. Every episode was equally as terrifying and physically taxing as the first, and these attacks began to alter his social life over time. He started to avoid having meals with others or rushing out of rooms to avoid being seen, which increased his actual risk of choking.

After nearly two years of misdiagnosis and taking medications that offered little relief, he was referred to a gastroenterologist specializing in allergy-related gastrointestinal conditions. An upper endoscopy finally revealed the cause—corrugations (rings), furrows in the mucosal lining, and extreme inflammation throughout the esophagus. Biopsies taken from his upper, middle, and lower esophagus confirmed Eosinophilic Esophagitis (EoE), a chronic, allergen-driven condition that inflames the esophagus and can severely impact swallowing by preventing an entire bolus from clearing the esophagus.

The diagnosis was both a relief and a disappointment. Even though we finally had the answers, there was a much longer and more taxing road ahead. At the time of diagnosis, there were no active medications to target EoE directly. His condition was treated with esophageal dilations, which were a short-term fix with limited effects. After six dilations, the doctors informed my dad that any further stretching would begin to tear the muscles within his esophagus. His mental health began to deteriorate because he could not enjoy the meals he had enjoyed all his life.

Fortunately, in May 2022, an injectable medication called Dupixent, typically used to treat eczema and asthma, was approved for the treatment of EoE in individuals older than 12. After three denials from insurance and months of bearing the effects of this disease, my dad was able to receive medication directly through the Dupixent MyWay® Program. He has not had an episode for over a year thanks to this medication. Even so, the years of undiagnosed symptoms left a lasting mark. His journey illustrates a sobering reality: EoE remains underrecognized by working medical professionals in all areas related to swallowing and gastrointestinal systems, often misdiagnosed as GERD or acid reflux even by experienced clinicians.

I graduated with my master’s in speech-language pathology from the University of North Texas in May of this year. During my graduate studies, I collaborated with Dr. Katsura Aoyama to review research studies on EoE and its relevance to our fields. Through this review, I learned that EoE is recognized as a rare form of dysphagia characterized by unique esophageal inflammation and motility challenges (Sun et al., 2020). EoE is frequently misdiagnosed or overlooked altogether because its symptoms often resemble GERD (Al-Hussaini et al., 2016; Potter et al., 2004). A definitive diagnosis requires an esophageal tissue biopsy to identify eosinophil density under high-power microscopy (Al-Hussaini, 2016; Potter et al., 2004; Sun et al., 2020), a procedure that is neither common nor routine.

Through my review of research articles, I learned the key differences between EoE and GERD. I also learned that my dad’s experience was similar to what was reported in previous studies (e.g., Croese et al., 2003; Potter et al., 2004). In particular, Croese et al. reported that the patients in their study experienced symptoms for a long duration of time, 45 months on average, before they were correctly diagnosed. One of the major contributors to misdiagnosis is the failure to recognize distinctive esophageal features such as rings, furrows, and strictures during endoscopic evaluation (Croese et al., 2003).

Although performing an upper endoscopy is beyond the scope of practice for a speech-language pathologist (SLP), their role in the multidisciplinary evaluation of dysphagia is essential. SLPs are often the first professionals to encounter patients struggling with swallowing (Sun et al., 2020). Additionally, during modified barium swallow studies, we may observe indirect indicators of EoE, including corrugation, a small-caliber esophagus, or signs of restricted bolus transit (Al-Hussaini et al., 2016). Beyond imaging, active listening and detailed documentation can reveal important diagnostic clues, such as self-imposed dietary restrictions, food allergies, bolus impaction episodes, or prior emergency visits for choking events (Sun et al., 2020).

My main goal for conducting this literature review was to equip SLPs with the knowledge necessary to advocate for individuals whose EoE may go undetected. Croese et al. (2003) emphasized that awareness of EoE is crucial to avoid misdiagnosis. SLPs can play a vital role in the diagnosis of EoE by documenting thoroughly and referring patients for appropriate follow-up care (Sun et al., 2020). By documenting our observations clearly and collaborating with gastroenterologists and allergists, SLPs can help reduce diagnostic delays and improve patient outcomes.

I presented this review of research at the University of North Texas research symposium in April 2025 and at the Texas Speech-Language-Hearing Association (TSHA) Convention in February 2026. We believe that the review of research studies combined with my dad’s story carries an important lesson for SLPs. Even in otherwise healthy patients, sudden dysphagia experiences and mealtime difficulties may signal EoE. Attentive listening, documentation of symptoms, and advocacy for appropriate referrals could make the difference between years of suffering and timely care. My dad’s experience demonstrates that listening carefully to patients and believing their descriptions are as vital as any test. SLPs have a unique opportunity to bridge the gap between patient-reported symptoms during swallow studies and medical intervention by doctors. By recognizing esophageal-phase dysphagia, documenting accurately, and communicating effectively with gastroenterologists, we can improve diagnostic timelines and patient outcomes.

Ultimately, raising awareness about EoE within the medical field, especially among SLPs, is an important step toward improving the lives of those who are misdiagnosed or unrecognized with EoE. Early recognition of EoE can prevent irreversible esophageal damage, strictures, and bolus impaction while also restoring patients’ comfort when eating and willingness to participate in social mealtimes, as evidenced by my dad’s story. Every clinician who hears a patient’s story has the potential to transform the trajectory of their care.

“It’s not just about diagnosing a disease,” my dad said. “It’s about feeling heard and finally being able to eat without feeling pain, fear, or embarrassment.” His words will forever serve as a reminder to me that the human experience is at the heart of an SLP’s clinical practice. For patients with EoE and those like my dad who are undiagnosed, attentive clinicians can be the difference between years of suffering and receiving effective and life-changing care.

References

Al-Hussaini, A., Abozeid, A., & Hai, A. (2016). How does esophagus look on barium esophagram in pediatric eosinophilic esophagitis? Abdominal Radiology, 41(8), 1466–1473. https://doi.org/10.1007/s00261-016-0712-0

Croese, J., Fairley, S. K., Masson, J. W. &., Chong, A. K. H., Whitaker, D. A., Kanowski, P. A., & Walker, N. I. (2003). Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointestinal Endoscopy, 58(4), 516–522. https://10.1067/s0016-5107(03)01870-4

Potter, J. W., Saeian, K., Staff, D., Massey, B. T., Komorowski, R. A., Shaker, R., & Hogan, W. J. (2004). Eosinophilic esophagitis in adults: An emerging problem with unique esophageal features. Gastrointestinal Endoscopy, 59(3), 355–361. https://doi.org/10.1016/S0016-5107(03)02713-5

Sun, R., Pesek, R., Kawatu, D., O’Neill, A., & Richter, G. T. (2020). Eosinophilic esophagitis. In J.S. McMurray, M. R. Hoffman, M. N. Braden, (Eds.), Multidisciplinary management of pediatric voice and swallowing disorders (pp. 399–411). Springer International. https://doi.org/10.1007/978-3-030-26191-7_37