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Dual Remission of Eosinophilic Esophagitis and Ulcerative Colitis With Dupilumab: A Case Report
Poster Abstract

Introduction

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by a T-helper 2 (Th2)–driven inflammatory response [1]. Ulcerative colitis (UC), although distinct, also involves dysregulated Th2-related pathways [2]. Dupilumab, a monoclonal antibody targeting IL-4Rα and modulating Th2 inflammation, has demonstrated efficacy in allergic disorders, including EoE [3]. Although theoretical concerns exist regarding IL-17 downregulation and potential inflammatory bowel disease (IBD) activation, current evidence does not indicate an increased risk of UC exacerbation [4]. We report a case of coexisting EoE and UC successfully managed with dupilumab and mesalazine.

Methods

A 43-year-old man with chronic atopic asthma treated with inhaled corticosteroids (ICS) and antihistamines was evaluated in 2019 for recurrent bloody diarrhea. Colonoscopy and biopsies confirmed UC and combined oral and rectal mesalazine induced clinical remission.In 2021, he developed reflux symptoms and dysphagia. Esophagogastroduodenoscopy (EGD) revealed distal esophagitis and a fixed ring, with 15 eosinophils/high-power field (HPF). After discontinuing ICS, a repeat EGD demonstrated edema, rings, and furrows (EREFS: E1R1Ex0F1S0) with >70 eosinophils/HPF, confirming EoE. High-dose proton pump inhibitor therapy failed to improve symptoms. Given persistent EoE and worsening asthma control, dupilumab was initiated.

Results

After three months of dupilumab, dysphagia resolved, and follow-up EGD showed near-complete mucosal healing (EREFS: E0R1Ex0F0S0) with 5 eosinophils/HPF. A same-visit colonoscopy demonstrated endoscopic and histologic remission of UC. At the 2025 follow-up, the patient maintained sustained clinical, endoscopic, and histologic remission of both EoE and UC under dupilumab and mesalazine.

Conclusions

This case highlights the efficacy and safety of dupilumab in a patient with concurrent EoE and UC, without IBD exacerbation. The findings support the potential role of Th2-targeted biologics in managing overlapping allergic and immune-mediated gastrointestinal diseases.