Dupilumab and Non-EOE GI Disorders

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Eosinophilic gastrointestinal disorders are characterized by eosinophil-rich inflammation in the gastrointestinal tract, with no known cause for eosinophilia. These disorders are divided into specific types based on their location such as - Eosinophilic esophagitis, Eosinophilic gastroenteritis or duodenitis, and eosinophilic colitis, proctitis, or proctocolitis. The etiology of these disorders is still no fully understood. Treatment includes steroids but recent approval of dupilimab for esophagitis has prompted interest in other eosinophilic conditions. Methods: Pubmed and Google Scholar were looked into with MeSH terms dupilumab, eosinophilic gastritis/enteritis/colitis/proctitis. Prisma guidelines were adhered to, a total of 12 results were brought on including 2 case series, 3 case reports, 3 incomplete randomized control trials and a meta-analysis comparing biologics in eosinophilic conditions. Rest were duplicates. The case series and reports were included. Results: The first case series included 12 pediatric patients with eosinophilic gastritis, duodenitis or both. All of them had failed initial steroid treatment and treatment with dupilumab led to remission in 5/12 patients and histologic improvement in 8/8 patients studied as measured by eosinophils/high power field. Similarlythe second series had steroid resistant gastritis, enteritis(jejunal and ileal) and colitis. All 3 patients had histologic improvement. Symptomatic improvement of at least 1 symptom was achieved in all patients. Rest 3 were case series, including eosinophilic colitis, egg-induced eosinophilic gastritis and ulcerative colitis with eosinophilic infiltrate. Symptomatic improvement was seen in all cases with histologic remission only studied in colitis case which showed reduced eosinophils per high powered field. Conclusion: Non-eosinophilic esophagitiseosinophilic diseases are rare but pose challenges of steroid dependence or resistance. With introduction of dupilumab in the field of eosinophilic esophagitis, interest has increased in all conditions with similar pathology. Our review shows promising results, there are phase 2 trials with dupilumab in these conditions especially ulcerative colitis with eosinophils.

Volume

119

Issue

10

First Page

S1609

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