Hospitalized Patients With Crohn’s Disease Are More Likely to Have Eosinophilic Esophagitis

Abstract

Introduction: Crohn’s Disease (CD) is a chronic inflammatory condition that can affect any part of the gastrointestinal tract. Multiple autoimmune conditions are known to be associated with CD. Eosinophilic esophagitis (EoE) is a chronic antigen-mediated inflammatory condition in the esophagus. We aim to explore the association between CD and EoE in an inpatient setting. Methods: This is a retrospective cohort study which utilized analysis of the 2010-2014 National Inpatient Sample (NIS) Database. We identified hospitalizations with an ICD-9 diagnostic code indicating EoE, and hospitalizations with an ICD-9 diagnostic code indicating CD. The primary aim of the study was to determine the odds ratio (OR) of EoE in CD population vs non-CD population. To ensure accuracy of any association, we also calculated the same OR after excluding hospitalizations with CD or asthma as the primary diagnosis. This was done to mitigate any potential effect of EoE on increasing readmission rates for CD or asthma. As NIS indentifies hospitalizations instead of individuals, this error could falsely elevate an OR. We also explored the association between EoE and other autoimmune conditions. Multivariate regression analysis was used to adjust for potential confounders. Results: The total number of EoE hospitalizations was 22,028 (mean age 31.8 years, 40% female, 71.4% white, 61.2% adults, 54.9% with private insurance). Of these, 430 hospitalizations carried diagnoses of both EoE and CD, with 38.1% admitted primarily for CD and 9.0% admitted primarily for EoE. The presence of CD was associated with increased odds of having EoE (OR 2.72, 2.15-3.44) after adjusting for various factor listed in table 1. Even after adjusting the study population by excluding hospitalizations with CD or asthma as the primary diagnosis, the results were unchanged (adjusted OR for CD: 2.71, 2.00-3.66). Of note, increased likelihood of EoE also was associated with atopy (OR 4.16, 3.77-4.59), celiac disease (OR 9.68, 7.10-13.20) and eosinophilia (OR 11.17, 7.73-16.15). Conclusion: Hospitalized patients with a diagnosis of CD were more likely to have EoE than those without a diagnosis of CD. Patients with EoE were generally white, younger, with lower severity of comorbidities, and had private insurance. While CD and EoE are not frequently noted in the same patient, this study indicates that their concurrent presence may be underestimated in the general population.372 Figure 1 No Caption available.