808 Clinical Course of Patients With Concomitant Eosinophilic Esophagitis and Inflammatory Bowel Disease

Abstract

INTRODUCTION: An overlap between eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD), both immune-mediated diseases of the gastrointestinal tract, is gaining recognition. However, the natural history and clinical implications of concurrent EoE and IBD remain to be characterized. We describe an institutional experience of patients with concurrent EoE and IBD. METHODS: We conducted a retrospective single-center case series of patients with diagnoses of EoE and either Crohn’s disease (CD) or ulcerative colitis (UC) seen between 01/01/2008 and 12/01/2018. Clinical data were analyzed for demographics, diagnostic findings, medical treatments, and disease outcomes. RESULTS: In our cohort, the prevalence (per 100,000 patients) of EoE, CD, and UC was 58.9, 111.4, 159.5, respectively. We identified 7 patients with both IBD (4 CD, 3 UC) and EoE. All were Caucasian, with median age 52 (SD 15.9), and 86% male. Median age at diagnosis of IBD was 25.5 (SD 17.4), and EoE was 50 (SD 15.9). Diagnosis of IBD preceded EoE in 6/7 patients, by an average of 14.3 years (range, 2-30 years). At the time of EoE diagnosis, IBD therapies included no therapy (29%), mesalamine (29%), ustekinumab (14%), or adalimumab/6-mercaptopurine (14%). EoE was treated with proton-pump inhibitor (PPI) in 4 patients (43%), elimination diet in 2 (29%), and/or swallowed fluticasone in 1 (14%). EoE complications, identified at time of EoE diagnosis, included 2/7 (29%) requiring esophageal stricture dilation. No further EoE complications developed following EoE treatment. CD complications preceded diagnosis of EoE, with 2 patients with perianal fistula, one with both ileal stricture and perianal fistula. No UC-associated or additional CD complications were identified after EoE diagnosis. Co-existing immune-mediated conditions included allergic rhinitis (43%), primary sclerosing cholangitis (14%), and rheumatoid arthritis (14%). CONCLUSION: In our cohort, diagnosis of IBD preceded EoE diagnosis by more than one decade, with EoE median age at diagnosis occurring later in IBD than that reported in non-IBD patients. Majority of disease-related complications in either IBD or EoE appear unrelated to concomitant diagnosis or treatment. Further studies are needed to examine immune-mediated pathways resulting in these concomitant diagnoses