Celiac Disease in Association With Eosinophilic Esophagitis

Introduction: Eosinophilic esophagitis (EE) is an emerging, worldwide chronic inflammatory disorder of the esophagus. Although EE is being frequently diagnosed, the true prevalence is not known except in small pockets including Hamilton County, Ohio and Olten County, Switzerland with a reported prevalence of approximately 1/2500. The prevalence of celiac disease (CD) is approximated at 1/100-1/300. CD has been associated with other medical conditions but an association with EE has not been previously described. We report a series of six children with both EE and CD seen at two tertiary care centers in Chicago, Illinois. Methods: A retrospective chart review of children who had an upper endoscopy over the last four years identified six children, (three males) with mean age of 8 years (range 5-14 years) who met the criteria for EE and CD. The histologic criteria for EE were > 20 esoinophils/HPF from distal or mid esophageal biopsies. Elevated tissue transglutaminase (IgA) and villous damage in duodenal biopsies were required for diagnosis of CD. Results: Four children presented with gastrointestinal symptoms including abdominal pain, diarrhea, constipation and failure to thrive. One patient each had short stature and delayed puberty. Three patients had diabetes mellitus and one with auto-immune thyroiditis. Atopy, including food allergy, was present in three children. All six patients had abnormal tissue transglutaminase and the three patients tested were all HLA DQ2 positive. Conclusions: We report a series of six children with CD and with esophageal histology consistent with EE. Similarities between the two conditions including genetic susceptibility, occurrence in asymptomatic individuals and classification as food hypersensitivity disorders as well as the risk of complication in untreated patients lead us to conclude that there is an association between the two conditions. Further studies are needed to delineate this association.