Epidemiology and implications of concurrent diagnosis of eosinophilic oesophagitis and IBD based on a prospective population-based analysis

Abstract

ObjectiveEosinophilic oesophagitis (EoO) and IBD are immune-mediated diseases of the gastrointestinal tract with possible overlapping pathogenic mechanisms. Our aim was to define the epidemiology and clinical implications of concurrent EoO and IBD diagnoses.DesignWe conducted a prospective cohort analysis using the Truven MarketScan database (2009–2016) to estimate the incidence and prevalence of EoO in patients with Crohn’s disease (CD) or UC and vice versa. Cox proportional hazards and Kaplan-Meier methods were used to estimate the risk of EoO-related or IBD-related complications among patients with concurrent diagnoses.ResultsAmong 134 013 536 individuals, the incidence of EoO, CD and UC were 23.1, 51.2 and 55.2 per 100 000 person-years, respectively. The risk of EoO was higher among patients with CD (incidence rate ratio [IRR] 5.4, p<0.01; prevalence ratio (PR) 7.8, p<0.01) or UC (IRR 3.5, p<0.01; PR 5.0, p<0.01), while the risk of IBD was higher among patients with EoO (CD: IRR 5.7, p<0.01; PR 7.6, p<0.01; UC: IRR 3.4, p<0.01; PR 4.9, p<0.01) versus individuals without either diagnosis. Concurrent diagnosis of EoO and IBD was associated with greater composite risk of IBD-related complications (CD: adjusted HR (aHR) 1.09, p=0.01; UC: aHR 1.10, p=0.04) but lower composite risk of EoO-related complications (aHR 0.59; p<0.01).ConclusionBased on a population-based prospective cohort analysis, the risk of EoO is significantly higher among patients with IBD and vice versa. Concurrent diagnoses might modify the risk of IBD-related and EoO-related complications. Studies defining the mechanisms underlying these observations are needed.

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

“…We found that patients with upper GI CD were significantly more likely to be male and to have a history of perianal surgery and smoking than patients with CD at other sites. Although male dominance of CD has been previously reported in Korea-unlike the relatively similar sex ratio in Western countries [21][22][23]-most upper GI CD patients were male but differences in sex were not statistically significant in the multivariate analysis (P = 0.084). One study reported that CD with perianal disease was associated with a more severe course of disease [24].…”

Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis

“…Although esophageal Crohn's disease exists, it is rare, with features distinct from EoE. 49 Systemic therapies for inflammatory bowel diseases might also reduce symptoms or features of EoE. Recognition of concomitant functional esophageal disorders in patients with EoE is important to avoid unnecessary escalation of Co-existent EoE and celiac disease reported in pediatric and adult case series, but an association between diseases is unclear.…”

“…EoE with IBD A 5-to 7-fold increased prevalence of EoE identified in patients with IBD (ulcerative colitis or Crohn's disease). 49 The association may reflect shared etiopathogenetic mechanisms. EoE with functional gastrointestinal disease Concomitant functional chest pain, functional heartburn, functional dysphagia, and nonulcer dyspepsia may confound symptom-based treatment approaches for EoE.…”

Early Life Risk Factors in Pediatric EoE: Could We Prevent This Modern Disease?

“…However, a significant number of EoE patients do not present allergic diseases, suggesting a possible non-atopic phenotype (2). Interestingly, several reports have suggested that EoE may be more frequently associated with some non-allergic disorders, including connective tissue disorders (74), autoimmune diseases (coeliac disease) ( 8), and contradictorily inflammatory bowel diseases (IBD) (8,(75)(76)(77), that are increased in the last decades, especially in Western countries (8). The pathogenetic mechanisms explaining the association between these non-atopic diseases and EoE are poorly understood and investigated.…”