High eosinophil levels in EoE despite minimal symptoms — hesitant about starting Dupixent

General Health Q&A
1

Greetings doctors,

I was diagnosed with eosinophilic esophagitis roughly 10 to 15 years ago. At that time, I was put on omeprazole (Prilosec), and allergy panels showed I was sensitive to several raw fruits and vegetables (like apples, oranges, and carrots).

While I haven’t always been consistent with the omeprazole, my symptoms have generally been mild—mostly an occasional feeling of my throat tightening, typically after drinking beer (especially wheat or citrus-flavored ones), white or sparkling wine, or sometimes Mexican cuisine. Otherwise, I rarely have noticeable issues.

About 5 years ago, my primary care physician referred me to a gastroenterologist. Since then, I’ve undergone several endoscopies and tried the following:

  • 10 mg omeprazole daily → no improvement
  • Steroid inhaler → no improvement
  • Steroid inhaler plus 10 mg omeprazole daily → no improvement
  • 10 mg omeprazole twice daily → no improvement

During one of my endoscopies, I had strictures that required dilation. My most recent procedure in October 2025 showed eosinophil counts above 40 in one biopsy and around 25 in another. My specialist is now recommending Dupixent.

My concern is that I experience very few symptoms—maybe one minor episode a year—and I’m wary of starting a long-term injectable medication for a condition that barely impacts my quality of life.

My questions are:

  1. Is there evidence of long-term damage (such as scarring, strictures, or cancer risk) if EoE is left untreated when symptoms are minimal?
  2. Are there patients who remain stable or avoid disease progression using only PPI therapy or regular monitoring?
  3. Is Dupixent ever used on a temporary basis for EoE, or is it typically an indefinite treatment?
  4. Are there alternative or less intensive treatment options for someone in my situation?

For context:

  • Female, early 30s
  • No other major health conditions
  • Family history: my father had symptoms similar to EoE long before it was a recognized diagnosis

Thank you in advance—I’m just trying to understand if the risk of undertreating this is greater than the potential downsides of starting Dupixent.

2

Is there any evidence of long-term risk (e.g., scarring, strictures, cancer risk) from leaving EoE untreated if symptoms are minimal?

Yes, there is. You have already had strictures that required dilation.

Are there patients who maintain stable disease avoid progression with just PPI therapy or monitoring?

No.

Has Dupixent ever been used on a temporary basis for EoE, or is it typically an indefinite treatment?

That depends on the individual case.

Are there any alternative or lower-intensity treatment options for someone in this situation?

There are several. What makes you reluctant to begin dupilumab?