The Association Between Celiac Disease and Eosinophilic Esophagitis in Children and Adults

Michael J Stewart; Eldon Shaffer; Stephan J Urbanski; Paul L Beck; Martin A Storr

Disclosures

BMC Gastroenterol. 2013;13(96) 

In This Article

Results

Over the five-year study period 421 patients were diagnosed with EoE. The age- and gender-adjusted incidence of EoE ranged from 2.1 cases per 100,000 population in 2004 to 10.7 cases per 100,000 population in 2008 (Table 1). As previously reported, over the same time period 763 patients were diagnosed with CD.[17] The age- and gender-adjusted incidence of CD ranged from 10.4 per 100,000 population in 2004 to 15.7 per 100,000 population in 2007 (Table 1).

When we looked at the gender distribution within the EoE and CD cohorts we found a significant male predominance for EoE with 82% (344) of patients being male. In contrast, within the CD cohort the opposite was true, only 32% (241) of patients were male (Figure 1).

Figure 1.

The Incidence of Celiac disease and eosinophilic esophagitis. Panel A) shows the incidence of both Celiac disease and eosinophilic esophagitis in males, per 100,000 population, age- and gender- adjusted, by year. Panel B) shows the incidence of Celiac disease and eosinophilic esophagitis in females, per 100,000 population, age- and gender- adjusted, by year.

Both conditions were commonly diagnosed in the pediatric age group. Among the EoE cohort, 83(20%) cases were diagnosed in patients younger than 19 years of age and within the CD cohort 245 (32%) cases were diagnosed in patients younger than 19 years of age. The age- and gender-adjusted incidence of EoE within the pediatric subpopulation ranged from 3.7 to 6.9 cases per 100,000 population. The age- and gender-adjusted incidence of CD within the pediatric subpopulation ranged from 9.5 to 22.7 cases per 100,000 (Table 1).

The diagnosis of both EoE and CD was made in three patients, all of whom were males in the pediatric age group. No adults were diagnosed with both conditions. The pertinent clinical, endoscopic and histological details are summarized in Table 2. Patient #1 was diagnosed with both conditions after presenting with a food bolus obstruction. At the time of EoE diagnosis the patient was on proton pump inhibitor (PPI) therapy and had a near-normal pH study. The diagnosis of CD was made by positive CD serology and Marsh III lesions on histology that normalized in response to a gluten-free diet. Patient #2 presented with abdominal pain and reflux and was diagnosed with EoE by the presence of the typical endoscopic and histologic findings. It is not clear if this patient was on a PPI or underwent a pH study. The diagnosis of CD was made by the presence of Marsh IIIb lesions and there was histologic normalization in response to gluten-free diet. Patient #3 presented with intermittent vomiting and at the time of EoE diagnosis he was on PPI therapy and had a near-normal pH study. The diagnosis of CD was made by positive serology and Marsh III lesions on histology. Repeat duodenal biopsies while on a gluten free diet showed mild villous blunting, however, CD serology normalized. None of the patients had evidence of gastric or duodenal eosinophilia on histology.

The SIR for EoE within the pediatric CD cohort was 48.4 (95% CI = 9.73, 141.41). Conversely, the SIR for CD within the paediatric EoE cohort was 75.1 (95% CI = 15.08, 219.28). These SIRs imply that the concurrent diagnosis of EoE and CD in late childhood/adolescence occurred at a rate 48 to 75 times greater than predicted by incidence rates in the same population.

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