Outgrowing eosinophilic esophagitis: it is possible
Monday, March 6, 2017: 2:30 PM
Rooms B312-B313 (Georgia World Congress Center, Building B)
Melanie A. Ruffner, MD PhD, , , , , , ,
Rationale: Eosinophilic esophagitis, unlike non-IgE mediated food allergy is generally thought to be lifelong with poor prognosis that patients will experience complete resolution of disease. 

Methods: We conducted a retrospective review of 1,812 EoE patients.  Inclusion criteria included: initial biopsies on proton pump inhibitor consistent with a diagnosis of eosinophilic esophagitis, if with removal of foods from the diet biopsies normalized and if at a subsequent date their biopsy results were normal on a full open diet unless an additional exclusion was required for IgE-mediated food allergy.

Results: We observe that 8 patients (5 males, 3 females, 75% Caucasian) had outgrown all EoE-related food sensitivities. This comprises 0.44% of our total EoE cohort. In these patients, age of EoE diagnosis was 7.2 ± 3.2 years and age of resolution was 11.9 ± 3.2years (mean ± st. dev). The duration of time from first diagnostic biopsy to complete food reintroduction was 1.5 to 9 years across this cohort. 7/8 of these patients were managed exclusively with dietary restrictions and during the majority of periods of dietary exclusion had zero eosinophils per high powered field in esophageal biopsies. Only one patient required brief periods of swallowed steroid therapy.  These 8 patients were followed for an additional 3.25 ± 2.3 years with no recurrence of symptoms.

Conclusions: Although this series represents a small portion of eosinophilic esophagitis patients, the confirmation that even a small proportion of patients with food-triggered eosinophilic esophagitis develops tolerance over time is novel and raises new questions about the pathogenesis of this disease.