001856 - Eosinophilic esophagitis (EoE). A case report

Introduction

Eosinophilic esophagitis (EoE) is a chronic type 2 inflammatory disease characterized by symptoms of esophageal dysfunction together with eosinophil-predominant inflammatory infiltration of the esophageal mucosa. Its pathogenesis involves, among other factors, a type 2 immune response to food and environmental antigens, leading to chronic inflammation, tissue remodeling, and, in advanced cases, esophageal strictures.

Case report

A 50-year-old woman presented with a two-year history of symptoms consisting of choking and food bolus impaction, mainly triggered by the ingestion of meat, rice, and tuna. She was being treated with proton pump inhibitors and orodispersible budesonide, without clear improvement. She reported no other medical history.

Materials and methods

Upper gastrointestinal endoscopy with biopsies was performed, revealing an edematous esophagus with reduced luminal caliber and no overt stricture. The mucosa had a trachealized appearance with rings. Multiple furrows and exudates were present, suggesting severe disease activity (EREFS 9).

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Figure 2.

Biopsies obtained from both the proximal and distal esophagus demonstrated esophageal mucosa with basal epithelial hyperplasia and exocytosis of 68–70 eosinophils, with microabscess formation. Based on these findings, the patient was diagnosed with poorly controlled EoE despite ongoing treatment with PPIs and budesonide. Treatment with dupilumab was initiated at a dose of 300 mg weekly.

Results

After 6 months of treatment, the patient reported clinical improvement. She experienced no further episodes of choking or food impaction and was able to resume eating meat without difficulty. Follow-up endoscopy showed mild rings with slight longitudinal furrows. Biopsies from the distal and proximal esophagus revealed usual histological features, with no increase in intraepithelial eosinophil counts, confirming not only clinical but also histological improvement.

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Conclusions

EoE has a significant impact on patients’ daily lives, including dietary restrictions and anxiety. In some cases, conventional treatments are insufficient, and alternative therapeutic approaches are required. Dupilumab, a monoclonal antibody that inhibits type 2 inflammation, which is central to the pathogenesis of EoE, has represented a new paradigm in the treatment of patients with refractory EoE, improving quality of life, symptoms, and disease severity, while reducing disease progression and overall disease burden.