Original articleAlimentary tractIncreased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy
Section snippets
Study Design and Data Source
This was a cross-sectional study of all patients with esophageal and duodenal biopsy specimens in a U.S national pathology database who were examined between January 1, 2009 and June 30, 2012 by pathologists at Miraca Life Sciences. Miraca Life Sciences is a specialized pathology laboratory serving outpatient endoscopy centers throughout the United States. They review samples from 43 states, Washington, DC, and Puerto Rico, with central specimen processing in 1 of 3 laboratories (Irving, TX,
Patient Characteristics
We identified 88,517 patients who had both esophageal and duodenal biopsies and who also met the inclusion criteria. The mean age in the group was 51.1 years, with 38.2% male (Table 1). The most common indication for upper endoscopy was abdominal pain/dyspepsia (52.1%), followed by heartburn (43.4%), dysphagia/odynophagia (16.5%), and diarrhea (13.4%). The mean of the maximum eosinophil count was 2.9 eos/hpf, and 1.1% had microabscesses.
There were 4101 patients (4.6%) who met criteria for
Discussion
Multiple and varied food antigens have been implicated in the pathogenesis of EoE, similar to the role gluten plays in celiac disease. On the basis of this, there is a question of whether the 2 conditions are associated. In the present study, which examined subjects with paired esophageal and duodenal biopsies in a large pathology database, we found that the odds of esophageal eosinophilia and our constructed case definitions of EoE were mildly increased in patients with celiac disease compared
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2019, Annals of Diagnostic PathologyCitation Excerpt :Sampling of the gastric antrum and duodenal mucosae can be helpful in distinguishing between these entities; detection of mucosal eosinophilia at these sites would support a diagnosis of eosinophilic gastroenteritis. There is also some literature suggesting a relationship between eosinophilic esophagitis and celiac disease, so sampling of the duodenum may be helpful when evaluating patients with upper gastrointestinal symptoms [11]. For these reasons, we recommend that the endoscopist obtain tissue samples from the gastric antrum and duodenum to assess for this condition when establishing an initial diagnosis of eosinophilic esophagitis.
Incidence and Prevalence of Pediatric Eosinophilic Esophagitis in Utah Based on a 5-Year Population-Based Study
2019, Clinical Gastroenterology and HepatologyCitation Excerpt :Esophageal furrowing was the most commonly noted mucosal change and over half of patients had at least 2 mucosal changes reported consistent with EoE (Table 3). A total of 4% of EoE cases were noted to have comorbid celiac disease at the diagnostic endoscopy, corroborating prior findings on the association between EoE and celiac disease.16 In this study, we sought to characterize the pediatric EoE incidence and prevalence in Utah over a 5-year period.
Environmental factors and eosinophilic esophagitis
2018, Journal of Allergy and Clinical ImmunologyCitation Excerpt :It should be noted that although most of the research on environmental factors in the development of EoE has been informed primarily by risk factors demonstrated to be associated with atopic disease, there is heterogeneity in the comorbid conditions experienced by patients with EoE, and in a proportion of patients (approximately 30%), the disease does not appear to be associated with having other atopic conditions. Indeed, for some patients with EoE, there appears to be increased co-occurrence of autoimmune conditions, including celiac disease, Crohn disease/ulcerative colitis, rheumatoid arthritis, IgA deficiency, multiple sclerosis, common variable immunodeficiency, and autoimmune thyroid disease.123-125 EoE has also been associated with tracheoesophageal fistulae, although even in those with co-occurring EoE and tracheoesophageal fistulae, 70% were indicated to have at least 1 or more additional atopic conditions.
Eosinophilic oesophagitis: Current evidence-based diagnosis and treatment
2018, Gastroenterologia y Hepatologia
Conflicts of interest These authors disclose the following: Benjamin Lebwohl has received research funding from Alvine. Robert Genta is an employee of Miraca Life Sciences. Evan Dellon has received research funding from Meritage Pharma, is a consultant for Aptalis, Novartis, Receptos, and Regeneron, and has received an educational grant from Diagnovus. The remaining authors disclose no conflicts.
Funding Supported in part by National Institutes of Health Award K23 DK090073 (E.S.D.).
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Authors share co-first authorship.
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Authors share co-last authorship.