Original article
Alimentary tract
Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy

https://doi.org/10.1016/j.cgh.2015.02.018Get rights and content

Background & Aims

The possible association between eosinophilic esophagitis (EoE) and celiac disease is controversial because prior results have been contradictory. We aimed to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies.

Methods

We conducted a cross-sectional study in a U.S. national pathology database by using data from January 2009 through June 2012. Our primary case definition was defined by the presence of esophageal eosinophilia with ≥15 eosinophils per high-power field. The crude and adjusted (for age and sex) odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett’s esophagus.

Results

Of 292,621 patients in the source population, 88,517 with both esophageal and duodenal biopsies were studied. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Odds of EoE were 26% higher in patients with celiac disease than in patients without celiac disease (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 0.98–1.60). The magnitude of association varied according to EoE case definition, but all definitions showed a weak positive association between the 2 conditions. There was no association between celiac disease and reflux esophagitis (aOR, 0.95; 95% CI, 0.85–1.07) or Barrett’s esophagus (aOR, 0.89; 95% CI, 0.69–1.14) and celiac disease.

Conclusions

There is a weak increase in EoE in patients with celiac disease. This association strengthened with increasingly stringent definitions of EoE and was not observed for other esophageal conditions. In patients with celiac disease, concomitant EoE should be considered in the correct clinical setting.

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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    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.).

    a

    Authors share co-first authorship.

    b

    Authors share co-last authorship.

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