How Common are Esophageal Eosinophilia and Eosinophilic Esophagitis in Children with Celiac Disease?

Celiac.com 03/23/2022 - There's not much solid data, and no clear consensus, on the connection between eosinophilic esophagitis and celiac disease. There seems to be no clear pattern to the conditions in which they occur together in patients. 

A team of researchers recently set out to investigate rates of esophageal eosinophilia and eosinophilic esophagitis in a large group of children with celiac disease, and to prospectively follow the group over an eleven year period.

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The research team included Fernanda Cristofori; Fulvio Salvatore D’Abramo; Vincenzo Rutigliano; Vanessa Nadia Dargenio; Stefania Castellaneta; Domenico Piscitelli; Davide De Benedittis; Flavia Indrio; Lidia Celeste Raguseo; Michele Barone; and Ruggiero Francavilla.

They are variously affiliated with the Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro” in Bari, Italy; the Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari “Aldo Moro” in Bari, Italy; the Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari “Aldo Moro” in Bari, Italy; the Department of Information Engineering, University of Pisa, Largo L. Lazzarino in Pisa, Italy; and the Department of Medical and Surgical Science, University of Foggia, Viale L. Pinto, 71122 Foggia, Italy.

The team used data from a prospective observational study performed between 2008 and 2019. They used ESPGHAN criteria to make celiac disease diagnosis. They sampled at least four esophageal biopsies in patients who underwent endoscopy. The team defined esophageal eosinophilia as at least 15 eosinophils/HPF seen on esophageal biopsy. They diagnosed eosinophilic esophagitis using the International Consensus Diagnostic Criteria for Eosinophilic Esophagitis. 

The team diagnosed a total of 465 children with celiac disease. A total of three hundred and seventy patients underwent endoscopy, while the team found esophageal biopsies for 313 of those. 

The rate of esophageal eosinophilia in children with celiac disease was 1.6%. Just a single child was diagnosed with eosinophilic esophagitis, for which the team calculated a prevalence rate of 0.3%. Overall, the team saw eosinophilic esophagitis in celiac patients at a rate at least 6.5 times higher than in the general population. 

According to the team, eosinophils over 15/HPF do not have a clinical implication or warrant intervention in celiac patients, so they do not recommend esophageal biopsies beyond what may be clinically indicated.

This is one of the first studies to put some hard numbers on the connection between eosinophilic esophagitis and celiac disease. The idea that people with celiac disease don't generally need to worry about eosinophilic esophagitis is one less thing to deal with in the often confusing world of living with celiac disease. 

Read more:  Nutrients 2021, 13(11), 3755