Review of Treatment Outcomes in Pediatric Patients with Concomitant Eosinophilic Esophagitis and Celiac Disease

Eosinophilic esophagitis (EoE) is a Th2-mediated disorder diagnosed by an esophageal biopsy with ≥ 15 eosinophils/HPF with associated esophageal symptoms. Celiac Disease (CD) is a Th1-mediated enteropathy characterized by dietary gluten sensitivity. An increased prevalence of EoE among pediatric CD patients has been described, however there is no consensus regarding treatment for these patients. We retrospectively reviewed medical records of pediatric patients with EoE or CD from 1/1/2004 - 02/29/2012 at our center, to evaluate treatment outcomes in patients with concomitant EoE and CD. One hundred forty-eight (67%) had EoE. Sixty-seven (30%) had CD. Six patients with CD (8.2%) also had EoE. All patients started a gluten-free diet (GFD). Four patients (67%) started an additional food elimination diet (AFED) and 5 (83%) started swallowed corticosteroids (SCS), for EoE. Four patients’ upper and lower GI symptoms clinically improved (67%). Despite clinical improvement, 3 of the 4 (75%) had no histological or endoscopic improvement of EoE. One patient (17%) improved significantly on GFD alone. Two patients (33%) did not improve clinically or histologically; both were on GFD, AFED, and SCS, but had suboptimal adherence. We report a higher prevalence in children of EoE in CD (8.2%) than other published studies (1.3-4.4%). GFD alone did not yield histological or clinical improvement of EoE in patients with concomitant CD. The addition of SCS and/or an AFED improved outcomes. Symptoms improved more than the histologic and endoscopic changes of EoE. In children, coexistent EoE and CD appears to require concerted treatment of both conditions.