A Case Series of Rapid Resolution of Pediatric Eosinophilic Esophagitis with Dupilumab Treatment as Demonstrated by Sedation-Free Transnasal Esophagoscopy (TN-Eso)

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus. Dupilumab, a treatment for EoE, requires an initial endoscopic evaluation no sooner than 12 weeks after initiation. As it is costly and pediatric patients often experience fear and pain associated with the injection, this could lead to non-adherence or premature cessation of therapy. Here, we report a case series, as part of a larger ongoing study, in which subjects demonstrated an earlier response to dupilumab. Three male subjects and one female subject, aged 13–21 years, with EoE started dupilumab therapy. Clinical symptoms resolved in all patients within two weeks. Each underwent a sedation-free transnasal esophagoscopy at 3–4 weeks and 6–8 weeks. All subjects tolerated the procedures without significant adverse events. Esophageal biopsies demonstrated persistent mucosal healing at both time points. These data suggest that dupilumab may achieve a therapeutic response sooner than previously thought. Further research is needed.