The Association Between Celiac Disease and Eosinophilic Esophagitis in Children and Adults

Overview

Journal BMC Gastroenterol

Publisher Biomed Central

Specialty Gastroenterology

Date 2013 Jun 1

PMID 23721294

Citations 20

Authors

Michael J Stewart

Eldon Shaffer

Stephan J Urbanski

Paul L Beck

Martin A Storr

Affiliations

Soon will be listed here.

Abstract

Background: An association between eosinophilic esophagitis (EoE) and celiac disease (CD) has been suggested in the literature. Our aim was to confirm and quantify the association between these two diseases.

Methods: All patients in a large Canadian city diagnosed with EoE or CD over a five-year period were identified. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated.

Results: Over the five-year study EoE was diagnosed in 421 patients and CD was diagnosed in 763 patients. The incidence of EoE ranged from 2.1 to 10.7 cases per 100,000 population. The incidence of CD ranged from 10.4 to 15.7 cases per 100,000 population. Among the EoE cohort, 83 (20%) cases of EoE and 245 (32%) cases of CD were diagnosed in pediatric patients. The incidence of EoE in the pediatric subpopulation ranged from 3.7 to 6.9 cases per 100,000 population. The incidence of CD in the pediatric subpopulation ranged from 9.5 to 22.7 cases per 100,000 population. The concomitant diagnosis of both EoE and CD was made in three patients, all of whom were pediatric males. The SIR for EoE in the CD cohort was 48.4 (95% CI = 9.73, 141.41) with a SIR for CD within the paediatric EoE cohort of 75.05 (95% CI = 15.08, 219.28).

Conclusions: This study confirms the association between EoE and CD. However, this association may be limited to pediatrics where the risk of each condition is increased 50 to 75-fold in patients diagnosed with the alternative condition. The concomitant diagnosis of these conditions should be considered in pediatric patients with upper gastrointestinal symptoms.

Citing Articles

Association of celiac disease with eosinophilic esophagitis: Nationwide register-based cohort study with sibling analyses.

Mitselou N, Uchida A, Roelstraete B, Melen E, Garber J, Katzka D J Allergy Clin Immunol Glob. 2024; 3(3):100254.

PMID: 38784439 PMC: 11112353. DOI: 10.1016/j.jacig.2024.100254.

Epidemiologic and Clinical Clues to the Etiology of Eosinophilic Esophagitis.

Chang J, Jensen E Immunol Allergy Clin North Am. 2024; 44(2):145-155.

PMID: 38575214 PMC: 11003716. DOI: 10.1016/j.iac.2023.12.003.

Otorhinolaryngological Manifestations and Esophageal Disorders in Celiac Disease: A Narrative Review.

Wieser H, Ciacci C, Gizzi C, Santonicola A J Clin Med. 2023; 12(22).

PMID: 38002650 PMC: 10672081. DOI: 10.3390/jcm12227036.

Association of eosinophilic esophagitis with autoimmune and connective tissue disorders, and the impact on treatment response.

Xue Z, Miller T, Abramson L, Thakkar K, Ketchem C, Reddy S Dis Esophagus. 2022; 36(1).

PMID: 35829628 PMC: 9817824. DOI: 10.1093/dote/doac043.

Increasing incidence of eosinophilic esophagitis in Sweden: a nationwide population study.

Garber J, Lochhead P, Uchida A, Roelstraete B, Bergman D, Clements M Esophagus. 2022; 19(4):535-541.

PMID: 35654916 DOI: 10.1007/s10388-022-00926-5.

References

Quaglietta L, Coccorullo P, Miele E, Pascarella F, Troncone R, Staiano A . Eosinophilic oesophagitis and coeliac disease: is there an association?. Aliment Pharmacol Ther. 2007; 26(3):487-93. DOI: 10.1111/j.1365-2036.2007.03388.x. View

Orenstein S, Shalaby T, Di Lorenzo C, Putnam P, Sigurdsson L, Mousa H . The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol. 2000; 95(6):1422-30. DOI: 10.1111/j.1572-0241.2000.02073.x. View

Thompson J, Lebwohl B, Reilly N, Talley N, Bhagat G, Green P . Increased incidence of eosinophilic esophagitis in children and adults with celiac disease. J Clin Gastroenterol. 2011; 46(1):e6-e11. DOI: 10.1097/MCG.0b013e318221aefd. View

Sollid L, Markussen G, Ek J, Gjerde H, Vartdal F, Thorsby E . Evidence for a primary association of celiac disease to a particular HLA-DQ alpha/beta heterodimer. J Exp Med. 1989; 169(1):345-50. PMC: 2189170. DOI: 10.1084/jem.169.1.345. View

Cook B, Oxner R, Chapman B, Whitehead M, Burt M . A thirty-year (1970-1999) study of coeliac disease in the Canterbury region of New Zealand. N Z Med J. 2004; 117(1189):U772. View

Furuta G, Liacouras C, Collins M, Gupta S, Justinich C, Putnam P . Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007; 133(4):1342-63. DOI: 10.1053/j.gastro.2007.08.017. View

Attwood S, Smyrk T, DeMeester T, Jones J . Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci. 1993; 38(1):109-16. DOI: 10.1007/BF01296781. View

Blanchard C, Wang N, Stringer K, Mishra A, Fulkerson P, Abonia J . Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis. J Clin Invest. 2006; 116(2):536-47. PMC: 1359059. DOI: 10.1172/JCI26679. View

Markowitz J, Liacouras C . Eosinophilic esophagitis. Gastroenterol Clin North Am. 2003; 32(3):949-66. DOI: 10.1016/s0889-8553(03)00047-5. View

10.

Ooi C, Day A, Jackson R, Bohane T, Tobias V, Lemberg D . Eosinophilic esophagitis in children with celiac disease. J Gastroenterol Hepatol. 2007; 23(7 Pt 1):1144-8. DOI: 10.1111/j.1440-1746.2007.05239.x. View

11.

Koyama K, Ozawa T, Hatsushika K, Ando T, Takano S, Wako M . A possible role for TSLP in inflammatory arthritis. Biochem Biophys Res Commun. 2007; 357(1):99-104. DOI: 10.1016/j.bbrc.2007.03.081. View

12.

Ozdemir O, Mete E, Catal F, Ozol D . Food intolerances and eosinophilic esophagitis in childhood. Dig Dis Sci. 2008; 54(1):8-14. DOI: 10.1007/s10620-008-0331-x. View

13.

Vitellas K, Bennett W, Bova J, Johnston J, Caldwell J, Mayle J . Idiopathic eosinophilic esophagitis. Radiology. 1993; 186(3):789-93. DOI: 10.1148/radiology.186.3.8430189. View

14.

Farrell R, Kelly C . Celiac sprue. N Engl J Med. 2002; 346(3):180-8. DOI: 10.1056/NEJMra010852. View

15.

Breslow N, Day N . Statistical methods in cancer research. Volume II--The design and analysis of cohort studies. IARC Sci Publ. 1987; (82):1-406. View

16.

Assaad A . Eosinophilic esophagitis: association with allergic disorders. Gastrointest Endosc Clin N Am. 2007; 18(1):119-32. DOI: 10.1016/j.giec.2007.09.001. View

17.

Cherian S, Smith N, Forbes D . Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia. Arch Dis Child. 2006; 91(12):1000-4. PMC: 2083004. DOI: 10.1136/adc.2006.100974. View

18.

Ebner S, Nguyen V, Forstner M, Wang Y, Wolfram D, Liu Y . Thymic stromal lymphopoietin converts human epidermal Langerhans cells into antigen-presenting cells that induce proallergic T cells. J Allergy Clin Immunol. 2007; 119(4):982-90. DOI: 10.1016/j.jaci.2007.01.003. View

19.

Oberhuber G, Granditsch G, Vogelsang H . The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999; 11(10):1185-94. DOI: 10.1097/00042737-199910000-00019. View

20.

Schuppan D . Current concepts of celiac disease pathogenesis. Gastroenterology. 2000; 119(1):234-42. DOI: 10.1053/gast.2000.8521. View