788 The Natural History and Treatment Outcomes of Concomitant Eosinophilic Esophagitis (EoE) and Inflammatory Bowel Disease (IBD)

Abstract

INTRODUCTION: Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are distinct chronic inflammatory conditions involving the gastrointestinal tract. The presence of eosinophilic infiltration in gastrointestinal mucosa has been observed as a histopathological feature of IBD, being described in both Crohn's disease (CD) and ulcerative colitis (UC). The natural history of patients with coexisting EoE and IBD has not been extensively studied. Our aim was to determine clinical characteristics and treatment outcomes in patients with concomitant IBD and EoE. METHODS: A retrospective cohort study was performed of all EoE patients who also had a diagnosis of IBD from January 2000 to December 2018. Patients were identified using ICD-9 and ICD-10 diagnostic codes. Confirmation of EoE and IBD diagnoses were required for inclusion in the study. Pertinent demographic and clinical data were extracted from the electronic medical record. Treatment outcomes and frequencies of disease-related complications were determined. RESULTS: Sixty-nine patients met inclusion criteria (68.1% male) with a median follow-up of 6 years. Forty-one patients had a diagnosis of CD (59.4%), 26 UC (37.7%), and 2 indeterminate colitis (IC) (2.9%). Forty-eight patients were diagnosed with IBD prior to EoE (69.6%). The most common treatments for EoE were proton pump inhibitors (78.3%) and topical steroids (59.4%) with 51.9% and 63.4% demonstrating clinical improvement, respectively (Table 1). The most common treatments for IBD were oral 5-aminosalicyclic acid (5-ASA) (69.6%), oral corticosteroids (66.7%), azathioprine (44.9%), and adalimumab (43.5%), with 37.5%, 43.5%, 35.5%, and 50% demonstrating clinical improvement, respectively (Table 2). Fifteen patients with CD (36.5%), 7 with UC (26.9%) and 1 with IC (50%) required surgical intervention for IBD. Eighteen patients with CD (43.9%), 8 with UC (30.8%), and 1 with IC (50%) required hospitalization for IBD (Table 3). CONCLUSION: Recent literature has shown an association between IBD and EoE. In our cohort, IBD is the more frequent initial diagnosis. As such, it is important to be vigilant for signs suggestive of EoE in patients with IBD and evaluate accordingly. It seems most patients with IBD and EoE respond to conventional treatment modalities used for each diagnosis. However, about 40% of patients with CD and EoE required hospitalization and/or surgical intervention, possibly suggesting a more severe phenotype in this specific subset of patients.