100532 - Phenotype-guided dupilumab therapy in multisegmental eosinophilic gastroenteropathy with systemic atopic disease

Phenotype-guided dupilumab therapy in multisegmental eosinophilic gastroenteropathy with systemic atopic disease

Background

Eosinophilic gastroenteropathy (EGE) is a chronic immune-mediated disorder characterized by eosinophilic infiltration of the gastrointestinal tract and heterogeneous clinical manifestations. As part of the eosinophilic gastrointestinal disease spectrum, EGE is driven by type 2 inflammation, and phenotypic characterization may guide targeted therapeutic selection. Dupilumab, a monoclonal antibody targeting the interleukin-4 receptor alpha (IL-4Rα), inhibits IL-4 and IL-13 signaling and has demonstrated efficacy in type 2–mediated eosinophilic disorders.

Methods

We report a 16-year-old male with eosinophilic gastroenteropathy involving the esophagus and stomach, with clinically predominant esophageal symptoms. He presented with progressive dysphagia and occasional food impaction. Endoscopy showed Los Angeles grade A esophagitis. Biopsies revealed eosinophilic infiltration of the esophagus (up to 50 eosinophils/HPF) and stomach (up to 100 eosinophils/HPF), consistent with active multisegmental involvement. The patient had concomitant allergic chronic rhinosinusitis with polysensitization to multiple aeroallergens. Laboratory evaluation showed elevated total IgE and peripheral eosinophilia. He was refractory to high-dose proton pump inhibitors and elimination diets. Dupilumab 300 mg subcutaneously every two weeks was initiated and continued for 6 months.

Results

After 6 months, complete clinical remission was achieved with full resolution of symptoms. Treatment was well tolerated. Follow-up assessment confirmed histological remission, consistent with effective control of eosinophilic inflammation.

Conclusion

In this adolescent with multisegmental eosinophilic gastroenteropathy and systemic atopic disease refractory to conventional therapy, dupilumab resulted in complete clinical and histological remission, supporting phenotype-guided targeting of the IL-4/IL-13 axis. Written informed consent for publication was obtained from the patient’s legal guardian.