Eosinophilic Esophagitis Associated with Celiac Disease in Children

Abstract

Purpose: Celiac disease (CD) and eosinophilic esophagitis (EoE) are distinct diseases of the gastrointestinal tract with specific clinico-pathological characteristics. Recent studies have found higher rates of EoE in patients with CD than in the general population. However, these studies were retrospective reviews and of predominantly adult populations. Our aim was to estimate the incidence of EoE among children diagnosed with CD at our center over a 36-month period. Methods: Patients diagnosed with CD based on endoscopy and histopathological findings from January 2010-December 2012 were included. Histopathology reports of esophageal biopsies were reviewed to identify all cases of EoE, defined as more than 15 eosinophils per high power field. The presenting symptoms, laboratory evaluations, histopathological findings, treatment, and follow-up of these patients were analyzed. Results: 56 patients with CD were identified, of whom six (10.7%) were diagnosed with both CD and EoE. Most of these patients (4/6) presented with abdominal pain and diarrhea, and two with failure to thrive. Food allergies were seen in three patients. An abnormal celiac screening test (positive for anti-tissue transglutaminase antibody IgA) was seen in all 6. Endoscopic changes typical of EoE were observed in five patients, while histopathological changes were evident in all six. Topical corticosteroid therapy plus a gluten-free diet was required in two patients, who showed clinical amelioration of symptoms with significant improvement in endoscopic and histopathological EoE findings after six months.Table: Table. The characteristics and clinical presentation of children with CD and EoETable: Table. Endoscopic, histopathological findings and treatment of children with CD and EoEConclusion: The incidence of EoE in our cohort of children with CD was 10.7%, which is higher than the reported for the general population. In all children undergoing upper gastrointestinal endoscopy for suspected CD, coexistent EoE should be considered. Esophageal biopsies should be obtained, irrespective of whether esophageal mucosa appears normal or abnormal at endoscopy.