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Oesophageal eosinophilia in children with coeliac disease
Anne Ari1,2, Sara Morgenstern3,4, Gabriel Chodick4
1Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel.
Insights
Children with coeliac disease (CD) and eosinophilic oesophagitis (EoE) share traits of both conditions. Treatment requires addressing both CD and EoE separately, as a gluten-free diet or proton pump inhibitors alone are often insufficient.
Area of Science:
- Gastroenterology
- Paediatric Medicine
- Immunology
Background:
- Coeliac disease (CD) and eosinophilic oesophagitis (EoE)/oesophageal eosinophilia (EE) are increasingly recognized conditions.
- An association between CD and EE has been suggested, but the distinct clinical characteristics and management of co-occurring CD and EE in children remain unclear.
Purpose of the Study:
- To characterize children with coeliac disease and eosinophilic oesophagitis (CD+EE) in-depth.
- To assess the contribution of each condition to the clinical presentation and treatment response in pediatric patients.
Main Methods:
- Retrospective review of medical records of children diagnosed with CD+EE or isolated EoE between 2000 and 2014.
- Comparison with patients having isolated CD or epigastric pain.
- Data collection via medical records and telephone questionnaires.
Main Results:
- Patients with CD+EE exhibited a mix of characteristics from both CD and EoE, including demographics, family history, and presenting symptoms.
- The majority of CD+EE patients initially presented with CD-associated symptoms, with many later developing typical EoE symptoms.
- Resolution of EE was uncommon with a gluten-free diet (21%) or proton pump inhibitors (21%), necessitating specific EoE treatments for most patients.
Conclusions:
- Pediatric patients with co-occurring CD and EE present with overlapping features of both conditions.
- These appear to be two distinct coexisting entities rather than EE being solely secondary to CD.
- Management strategies should consider separate interventions for both CD and EE in affected children.
Objectives:
An association between coeliac disease (CD) and eosinophilic oesophagitis (EoE)/oesophageal eosinophilia (EE) has been suggested. We sought to characterise children with CD+EE in-depth and assess the contribution of each condition to the clinical presentation and treatment response.
Study Design:
Medical records of children with both CD+EE, or isolated EoE diagnosed between 2000 and 2014, were retrospectively reviewed and compared with patients with isolated CD or epigastric pain. Frequency of EE was calculated from endoscopy results of patients with suspected CD or epigastric pain between 2011 and 2014. Missing data were obtained via a telephone questionnaire.
Setting:
Single large, tertiary paediatric centre.
Patients:
17 CD+EE, 46 EoE, 302 isolated CD and 247 epigastric pain.
Results:
The patients with CD+EE shared characteristics of both individual conditions. While age at diagnosis, family history of autoimmunity/CD and anaemia were similar to patients with CD, other characteristics such as male gender, personal/family history of atopy, peripheral eosinophilia and oesophageal white papules were more similar to patients with EoE. Combined patients (CD+EE) tended to present with CD-associated symptoms; the majority (63%) later developed typical EoE symptoms. Only a minority (21%) of combined patients had EE that resolved after a gluten-free diet; another 21% had normalisation of EE upon proton pump inhibitor treatment. The remainder required EoE-specific treatment.
Conclusion:
Patients with CD found to have EE share characteristics with both isolated CD and EoE. It appears that these are two coexisting entities presenting in the same patient rather than eosinophilia associated with CD, and therefore, interventions separately addressing each condition may be considered.