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Original article
Oesophageal eosinophilia in children with coeliac disease
  1. Anne Ari1,2,
  2. Sara Morgenstern3,4,
  3. Gabriel Chodick4,
  4. Manar Matar1,
  5. Ari Silbermintz1,
  6. Amit Assa1,4,
  7. Yael Mozer-Glassberg1,4,
  8. Firas Rinawi1,
  9. Vered Nachmias-Friedler1,
  10. Raanan Shamir1,4,
  11. Noam Zevit1,4
  1. 1 Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel
  2. 2 Pediatrics C, Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel
  3. 3 Pathology, Rabin Medical Center, Petach Tikvah, Israel
  4. 4 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  1. Correspondence to Dr Noam Zevit, Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; nzevit{at}gmail.com

Abstract

Objectives An association between coeliac disease (CD) and eosinophilic oesophagitis (EoE)/oesophageal eosinophilia (EE) has been suggested. We sought to characterise children with CD+EE in-depth and assess the contribution of each condition to the clinical presentation and treatment response.

Study design Medical records of children with both CD+EE, or isolated EoE diagnosed between 2000 and 2014, were retrospectively reviewed and compared with patients with isolated CD or epigastric pain. Frequency of EE was calculated from endoscopy results of patients with suspected CD or epigastric pain between 2011 and 2014. Missing data were obtained via a telephone questionnaire.

Setting Single large, tertiary paediatric centre.

Patients 17 CD+EE, 46 EoE, 302 isolated CD and 247 epigastric pain.

Results The patients with CD+EE shared characteristics of both individual conditions. While age at diagnosis, family history of autoimmunity/CD and anaemia were similar to patients with CD, other characteristics such as male gender, personal/family history of atopy, peripheral eosinophilia and oesophageal white papules were more similar to patients with EoE. Combined patients (CD+EE) tended to present with CD-associated symptoms; the majority (63%) later developed typical EoE symptoms. Only a minority (21%) of combined patients had EE that resolved after a gluten-free diet; another 21% had normalisation of EE upon proton pump inhibitor treatment. The remainder required EoE-specific treatment.

Conclusion Patients with CD found to have EE share characteristics with both isolated CD and EoE. It appears that these are two coexisting entities presenting in the same patient rather than eosinophilia associated with CD, and therefore, interventions separately addressing each condition may be considered.

  • Coeliac disease
  • Eosinophilic oesophagitis
  • eosinophilic esophagitis
  • celiac disease
  • esophageal eosinophilia

https://doi.org/10.1136/archdischild-2016-311944

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    Footnotes

    • Contributors NZ conceptualised and designed the study, analysed data, drafted the initial manuscript and approved the final manuscript as submitted. AA assisted in designing the study, performed the data acquisition and collection, carried out the analyses, drafted the initial manuscript and approved the final manuscript as submitted. RS conceptualised and designed the study, critically reviewed the manuscript and approved the final manuscript as submitted. SM supervised pathological data collection, reviewed the manuscript and approved the final manuscript as submitted. GC helped design the study parameters, performed the statistical analyses, reviewed the manuscript and approved the final manuscript as submitted. MM, AS, AA, YMG, FR and VNF assisted in data acquisition, critically reviewed the manuscript and approved the final manuscript as submitted.

    • Competing interests None declared.

    • Ethics approval This study was approved by the local institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.