Study reveals a distinct subtype of eosinophilic esophagitis

by Ann & Robert H. Lurie Children's Hospital of Chicago

edited by Gaby Clark, reviewed by Andrew Zinin

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Researchers from Ann & Robert H. Lurie Children's Hospital of Chicago identified a distinct subtype of eosinophilic esophagitis (EoE)—a chronic allergic inflammatory disorder in which the esophagus narrows, interfering with food passing properly. They found that 25% of children with EoE have hypermobile joints, meaning their joints can bend beyond the normal range of motion. These patients also tend to experience autonomic symptoms, most commonly chronic lightheadedness upon standing. This combination of symptoms leads to a significantly worse quality of life, according to the study published in the Journal of Allergy and Clinical Immunology.

"With recognition of this disease subtype, clinicians need to routinely screen children with EoE for hypermobility and chronic lightheadedness because we have simple treatments for these symptoms that can make a huge difference in these children's quality of life," said senior author Joshua Wechsler, MD, MS, medical director of the Eosinophilic Gastrointestinal Diseases Program at Lurie Children's and assistant professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine.

"Patients often don't mention lightheadedness on their own, since they might not pay much attention to brief episodes. But they might mention headache that commonly appears afterward," he added. "So, if chronic headache comes up, clinicians need to specifically ask if lightheadedness precipitated it. Importantly, patients with EoE are advised to talk about these non-GI symptoms with their doctor."

Treatment for chronic lightheadedness includes increased fluids, salt and exercise. Hypermobility requires aggressive physical therapy, since muscles around the joints need to be strong to prevent frequent injuries and dislocations.

In the study, 80 EoE patients, ages 2–21, completed validated surveys about their symptoms and quality of life. Both active EoE and hypermobility were associated with autonomic symptoms. Lightheadedness upon standing was more common in girls with EoE.

"The associations we found between EoE, hypermobility and autonomic dysfunction hopefully will spur more research and potentially offer new clues as to how EoE develops," Wechsler said. "We still don't know if these associations occur just with EoE or with other inflammatory diseases as well. Our findings open the door to exciting research directions."

Publication details

Ritam H. Patel et al, Dysautonomia and joint hypermobility reflect a distinct subtype in eosinophilic esophagitis, Journal of Allergy and Clinical Immunology (2026). DOI: 10.1016/j.jaci.2026.05.027

Journal information: Journal of Allergy and Clinical Immunology

Key medical concepts

Eosinophilic EsophagitisHypermobilities, JointPrimary Dysautonomias

Clinical categories

Allergy and immunologyPediatricsGastroenterologyChildren's healthCommon illnesses & Prevention Provided by Ann & Robert H. Lurie Children's Hospital of Chicago Who's behind this story?

Gaby Clark

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