A Case Series of Patients With Eosinophilic Esophagitis and Crohnʼs Disease

Abstract

Introduction: Eosinophilic Esophagitis (EoE) is well described in the literature as a distinct entity, with a unique clinical and histological profile. It has been associated with other atopic conditions such as asthma and autoimmune conditions such as celiac disease. Crohn's disease is an autoimmune inflammatory condition that can affect any portion of the gastrointestinal tract. To date, there has been no association between EoE and CD. We present the first case series of patients with both EoE and CD. Methods: A retrospective analysis of a prospectively maintained endoscopy database was carried out at a tertiary referral center. Data extracted included demographics, age of diagnosis, EoE symptoms, endoscopic and histological findings, location of CD, duration of CD, presentation of CD and treatment. Results: 6 patients, all Caucasian, were diagnosed with both EoE and CD between 2003 and 2014. The median age was 53 years (range of 36-74). Five (83%) patients were male. All patients were first diagnosed with CD disease and subsequently with EoE. The median time to diagnosis of EoE was 23 years (range of 1 to 34 years). EGD revealed typical esophageal findings of EoE (table 1), and histology revealed 20-69 eosinophils / hpf. In 2 patients, EoE was treated with oral prednisone, 2 with oral viscous budesonide, and 1 patient each with topical fluticasone and a proton pump inhibitor. Three patients (50%) had stricturing CD, 1 (17%) had both stricturing and fistulizing CD, 2 (33%) had non-stricturing non-fistulizing CD. Three patients (50%) had ileal CD, 1 (17%) had involvement of ileocolonic anastomosis and left colon, 1 (17%) had ileal and perianal CD, and 1 had ileocolonic CD. At the time of EoE diagnosis, 3 (50%) patients were on treatment with adalimumab, 1 (17%) on infliximab and 2 (33%) on oral budesonide. Patient characteristics are summarized in Table 1.Table 1Conclusion: To our knowledge, this is the first case series of patients with both CD and EoE. CD preceded the diagnosis of EoE in all patients in our series, with a median time of 23 years for diagnosis of EoE. The majority of patients had symptomatic EoE, and typical endoscopic and histologic findings despite treatment with an anti TNF agent. Clinicians should have a high index of suspicion for EoE in patients with CD who present with dysphagia, food impaction, heartburn or atypical chest pain.