S1553 Association of EoE and Celiac Disease in a National VA Database

Abstract

Introduction: Conflicting evidence exists regarding the association between Eosinophilic Esophagitis (EoE) and Celiac Disease, leaving clinicians questioning whether it is necessary to perform small bowel biopsies during endoscopy for patients with EoE. We sought to assess the relationship between EoE and Celiac Disease in a large population-based study to better assess the utility of this procedure in this setting. Methods: We performed a nationwide, retrospective case control study using patient data from the Department of Veterans Affairs electronic health records (EHR). Using ICD9 and ICD10 codes, patients with EoE (530.13, K20.0) and Celiac Disease (579.0, K90.0) were identified. The prevalence of EoE in Celiac Disease and the prevalence of Celiac Disease in EoE, as well as odds ratios of the respective conditions, were determined. Results: Using a random sample of 1,110,189 VA patients, we identified 1,022 cases of EoE (0.092%) and 1,285 cases of Celiac Disease (0.116%), where the prevalence of Celiac Disease within the EoE cohort was found to be 1.08% (n=11), reflecting an elevated odds of Celiac in EoE (OR= 9.46, 95% CI: 4.89,16.32) (Table). Additionally, the prevalence of EoE within the Celiac cohort was 0.86%, which also indicated an elevated odds of EoE in Celiac Disease (OR= 9.46, 95% CI: 4.89,16.32) (Table). Adjusting for race, ethnicity, and gender resulted in a similar OR (OR=8.66, CI: 4.47, 14.95). When stratified by race and ethnicity, we found that all patients with both EoE and Celiac Disease were White and non-Hispanic. When stratified by gender, 10 of the 11 patients with both EoE and Celiac Disease were found to be male. Conclusion: The results of our study show that there is an increased odds of Celiac Disease within EoE and vice versa in VA patients when compared to the general population. These results suggest that in EoE and Celiac patients, Celiac Disease and EoE should be actively looked for and that there should be a low threshold to biopsy, especially if there are any symptoms or mucosal changes that are suggestive of disease. However, further research into the association of Celiac Disease and EoE with prospective studies are needed. Table 1. - Prevalence of EoE and Celiac Disease among patients in the VA EHR Patients with EoE Patients without EoE Patients with Celiac Disease 11 1,274 Patients without Celiac Disease 1,011 1,107,893