Disease Resolution after Cessation of Treatment in Patients with Eosinophilic Esophagitis

Background and aims: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. EoE is triggered in most patients by dietary allergens and mediated by type 2 immune responses. Over the past 3 decades, substantial progresses have been made in understanding EoE pathogenesis, management, and natural history. EoE affects children and adults, and the incidence and prevalence have increased over time. Untreated EoE can lead to severe complications including food impaction, small caliber esophagus, esophageal stricture, and esophageal perforation. EoE can be managed by dietary elimination, swallowed steroids, proton pump inhibitor, and biologics to achieve both clinical and tissue remission. Patients’ quality of life is significantly improved with effective EoE management. Thus far, reports on treatment-free remission in EoE patients without any treatment is rather scattered. Methods: We identified 7 EoE patients at our Massachusetts General Hospital Food Allergy Center via routine clinical care with treatment-free remission. Clinical charts and EGD biopsy reports were reviewed and analyzed. Results: We report 7 EoE patients who achieved treatment-free remission over time. In all 7 patients, their active EoEs were responsive to either diet elimination treatment or swallowed steroid treatment in both clinical symptoms and tissue eosinophilia of the esophagus for a variable period. The treatment-free status was achieved after their treatment was stopped for longer than 12 months in 4 of the 7 patients. Conclusions: We have reported 7 EoE cases, in whom all achieved treatment-free disease resolution after cessation of previous management and the treatment-free disease resolution lasted 12 months or longer. The precise mechanism and rate of the treatment-free remission need further investigation.