Attenuation of Endoscopic Inflammatory and Stenotic Features in Patients with Co-existing Eosinophilic Esophagitis and Inflammatory Bowel Disease

Abstract

Introduction: Eosinophilic esophagitis (EoE) has become an increasingly well-described disease entity characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation of esophageal mucosa. EoE has been associated with atopic and autoimmune diseases. This study compares clinical and endoscopically identified esophageal manifestations of patients with EoE and inflammatory bowel disease (IBD) concomitantly to patients with EoE alone. Methods: Data from 22 patients with concomitant EoE and IBD (64% with Crohn's disease) and 50 control patients with EoE alone between 1993 and 2014 was retrospectively evaluated. Clinical charts of patients between ages 18-80 years old were identified using ICD-9 codes (EoE: 530.13; CD: 555.9, 555.1, 555.2, 555.0; UC: ICD-9 556.9, 557.0, 556.5, 556.3, 556.6) by our Enterprise Data Warehouse (EDW). EoE controls were tested to not be statistifically significantly different from patients with concomitant EoE and IBD in gender, race, or age. Demographic and disease-specific characteristics, endoscopic findings using a validated instrument (EoE Endoscopic Reference Score), histopathology, and treatment in patients with concomitant IBD and EoE were examined. Bivariate analysis with the chi-square test was used to look for statistical significance between the two groups.Table 1: Demographics and Disease-specific Characteristics of Concomitant EoE and IBD Compared to EoE AloneResults: Patients with concomitant EoE and IBD compared to EoE alone were found to have significantly less strictures (9% vs 58%, p=0.0001), furrows (64% vs 92%, p-0.003) and exudates (18% vs 56%, p=0.003) on endoscopy (Table and Figure 1). Of the 22 patients with concomitant EoE and IBD, 11 patients (50%) were treated with immunomodulators including anti-TNF agents, 6-MP, azathioprine and methotrexate for IBD, and 0/11 of these patients had strictures. Patients with EoE and IBD compared to EoE alone were also found to present less frequently with dysphagia as an initial symptom (68% vs 88%, p=0.04).Figure 1Conclusion: Patients with concomitant EoE and IBD demonstrated significantly lower prevalence of endoscopically identified inflammatory (furrows, exudate) and remodeling (stricture) features compared to EoE patients alone. The decreased activity of EoE in patients with concomitant EoE and IBD may be related to immunomodulator therapy used to treat IBD or earlier diagnosis of EoE owing to healthcare utilization amongst IBD patients.