Comorbid Diagnosis of Eosinophilic Esophagitis and Inflammatory Bowel Disease in the Pediatric Population

Abstract

Background and Aims: The incidence and prevalence of eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are rising with similar patterns. Co-occurrence of both diseases in the same patient has been increasingly reported. We sought to examine the pediatric population with both EoE and IBD to better understand the epidemiology and clinical implications of this overlap. Methods: We conducted a retrospective case-control study at 2 tertiary care children's hospitals. Subjects with both EoE and IBD were identified and compared with randomly selected controls with EoE and IBD alone in terms of: demographics, atopic conditions, IBD classification, location and phenotype of Crohn disease (CD), IBD medications, endoscopic findings, and histopathology. Descriptive statistics summarized the data. Results: Sixty-seven subjects with dual-diagnosis were identified across both institutions. The prevalence of IBD in the EoE population was 2.2% and EoE in IBD was 1.5%. Subjects with both diseases were more likely to have IgE-mediated food allergy compared with IBD alone (36% vs 7%, P < 0.001). Subjects with CD-EoE were less likely to have perianal disease than CD alone (2% vs 20%, P = 0.004). There was no difference in fibrostenotic EoE between the dual-diagnosis group and EoE alone. Treatment with a TNF-alpha inhibitor (anti-TNF) for management of preexisting IBD was protective against development of EoE with a relative risk of 0.314 [95% confidence interval [CI] 0.159-0.619]. Conclusions: This is a unique population in whom the underlying pathway leading to dual-diagnosis is unclear. Concomitant atopic conditions, especially IgE-mediated food allergy, and medication exposures, particularly anti-TNFs, may help predict likelihood of developing dual-diagnosis.

Differences in Clinical Presentation of Eosinophilic Esophagitis in Pediatric Patients With Ulcerative Colitis and Crohn Disease

“…They noted that the rate of EoE diagnosis per initial EGD increased 4-fold for CD and 5-fold for UC between 2009 and 2016 even though the number of EGD's remained stable, suggesting that the number of patients with EoE and IBD is increasing faster for UC than CD. Moore et al (10) described 67 pediatric patients with EoE and IBD from a population of 4515 IBD patients and 3053 EoE patients (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). The prevalence of IBD in the EoE population was 2.2% and EoE in the IBD population was 1.5%.…”

“…Recent studies have reported an association of EoE and IBD (8,10–13). In this single center study, we found 8.8% of our IBD population had EoE and 9.4% of our EoE patients had IBD.…”

Eosinophilic gastrointestinal disorders in patients with inborn errors of immunity: Data from the USIDNET registry

“…Among our cohort, 5 patients had concurrent EoE and IBD, including one patient with CGD SCID, CVID, and IPEX and one within the "other" category. EoE is increasingly recognized to co-occur with inflammatory bowel disease (38)(39)(40), and in some cohorts, the patients are more likely to be male, present at a younger age, and be associated with comorbid atopic disorders (41). It is important to note that mucocutaneous candidiasis can cause secondary gastrointestinal eosinophilia (13,27,28).…”

Heterotopic Gastric Mucosa Causing Rectal Bleeding in a Young Child

“…The recent retrospective case-control study found the prevalence of IBD among pediatric EoE patients to be significantly higher than EoE and IBD alone in the general population (2.2% compared to 0.4% in the general population). 7 This association and other etiologies of rectal bleeding prompted the clinical team to proceed with colonoscopy, leading to the diagnosis of HGM in the rectum. Clinical features of HGM can mimic IBD and may be difficult to differentiate without histological evaluation.…”