Elemental Diet Achieves Deep Remission in Dupilumab-Responsive EoE

Presented at ACG 2025 | Read Full Study | Watch Video

For patients with eosinophilic esophagitis (EoE), combining nutritional therapy with biologics may unlock deeper remission. A case presented at ACG 2025 followed a man with PPI-refractory EoE who had a limited response to dupilumab. After following 2 weeks of mBIOTA for the management of a separate condition (intestinal methanogen overgrowth), the patient’s dysphagia (trouble swallowing) completely resolved. An endoscopy was performed to investigate the impact of the combination of mBIOTA with biologic therapy.

Initially, treatment with weekly dupilumab improved endoscopic appearance and eliminated eosinophils on biopsy, but functional testing showed poor esophageal distensibility, and the patient continued to experience mild dysphagia. After a two-week exclusive elemental diet taken to manage intestinal methanogen overgrowth (IMO), the patient’s dysphagia resolved completely. Repeat endoscopy demonstrated full mucosal healing with an EREFS score of 0, and esophageal distensibility normalized on functional testing. Symptom relief and objective improvements were maintained at three months of follow-up.

This case supports the use of elemental diets alongside biologics to help patients achieve not just histologic, but functional and symptomatic remission. Previous studies of Elemental Diets for EoE struggled to maintain remission after resuming a normal diet, but in this case, the combination of mBIOTA and duplimab was able to give this patient long-lasting relief. mBIOTA was able to address their IMO, and had the added benefit of improving their response to duplimab, bringing relief from both conditions. This case highlights the potential of combining dupilumab with the mBIOTA Elemental Diet to induce deeper remission in EoE patients who respond only partially to biologic therapy.