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Updated: Oct 20, 2025
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Association of celiac disease with eosophageal eosinophilia and eosinophilic eosophagitis
Nafiye Urganci1, Merve Usta1, Zeynep Civelek2
1Division of Pediatric Gastroenterology, SBU Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Insights
This study found no direct link between celiac disease and eosinophilic esophagitis in children. Follow-up biopsies confirmed resolution of esophageal eosinophilia after a gluten-free diet.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Gastrointestinal Pathology
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten.
- Eosinophilic esophagitis (EoE) is an allergic inflammatory condition of the esophagus.
- The potential association between CD and esophageal eosinophilia requires further investigation in pediatric populations.
Purpose of the Study:
- To investigate the association between celiac disease and eosinophilic esophagitis or esophageal eosinophilia in pediatric patients.
- To evaluate clinical, endoscopic, and histopathological findings in children with celiac disease.
Main Methods:
- Retrospective analysis of 278 pediatric patients diagnosed with celiac disease.
- Evaluation of esophageal biopsy specimens for eosinophil counts.
- Assessment of relevant genetic markers (HLA DQ2/DQ8) and serological markers (tissue transglutaminase IgA, total IgE).
Main Results:
- Celiac disease was confirmed by Marsh classification (3A, 3B, 3C) in all patients.
- Only 1.4% of patients showed esophageal eosinophilia (<15 eosinophils/HPF).
- Esophageal eosinophilia resolved in these patients after a 3-month gluten-free diet, with decreased tissue transglutaminase IgA levels.
Conclusions:
- This study did not establish a definitive association between celiac disease and eosinophilic esophagitis/esophageal eosinophilia in children.
- This research is the first to document the resolution of esophageal eosinophilia through follow-up GI endoscopy and biopsies.
- The findings suggest that esophageal eosinophilia in celiac patients may be transient and responsive to dietary intervention.
Background:
Aim of the study was to evaluate the association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia in children.
Methods:
A total of 278 patients with celiac disease (mean age: 7.12 ± 4.64 years, M/F: 0.77) were involved in the study. The patients were evaluated retrospectively in terms of clinical, endoscopic and histopathological findings. The association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia was determined.
Results:
According to Marsh classification system 6 (2.1%) of the patients were graded type 3A, 10 (3.5%) were type 3B, 262 (94.4%) were type 3C. The histopathological examination of oesophageal biopsy specimens of the patients revealed <15 eosinophils per high power field in only 4 (1.4%) patients. Two of these patients were positive for HLA DQ8, one was DQ2, and the other one was both DQ8 and DQ2. Tissue transglutaminase IgA level was above 300 U/mL in these patients. None of them had elevated serum total IgE levels, peripheral eosinophilia and history of atopic diseases. The gastrointestinal symptoms resolved and tissue transglutaminase IgA level of the patients were declined after 3 months of gluten-free diet.
Conclusion:
Although an association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia have been postulated in recent years, no exact relationship was established in this study. This is the first study reporting the performance of follow-up GI endoscopy with biopsies revealing the resolution of oesophageal eosinophilia.
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