EoE: Evidence of Healing and Possible Sustained Untreated Remission
Abstract
The course of eosinophilic oesophagitis (EoE) in this case raises an important question: how should suppression of disease activity, healing of the oesophageal mucosa, and possible sustained untreated remission be distinguished? The EoE had previously required active swallowed topical corticosteroid therapy, initially with budesonide orodispersible treatment and subsequently with swallowed fluticasone (Flixotide) each evening. This therapy was directed at controlling eosinophilic inflammation within the oesophageal mucosa, rather than merely relieving symptoms. There has now been an approximately eight-week period during which no EoE-specific swallowed corticosteroid therapy has been required and no recognisable flare-up has occurred. The previous symptomatic pattern has not apparently recurred. This raises the possibility that the oesophagus is maintaining remission after treatment withdrawal and, more cautiously, that a degree of sustained treatment-independent recovery may be occurring. This observation is clinically encouraging, but it must be interpreted in the context of the known biology and natural history of EoE.