Patients with eosinophilic esophagitis (EoE) present with symptoms accompanied by behavioral adaptions to living with this condition. These include swallowing- and nonswallowing-associated pain in adulthood. In children, EoE symptoms vary with age and include vomiting, abdominal pain, and dysphagia. Studies using validated patient-reported outcome measures have demonstrated that symptoms in EoE are associated with severe biologic alterations and that patients on the low biologic severity spectrum have few symptoms. This nonlinear nature of the relationship between symptoms and biologic findings has important implications for among other things the length of diagnostic delay, selection of patients for clinical trials, trial duration, and long-term management of EoE patients.