J Pediatr Gastroenterol Nutr. 2020 Nov 20. doi: 10.1097/MPG.0000000000003002.Online ahead of print.

Hillary Moore ^1 2, Joshua Wechsler ^3 4, Carrie Frost ⁵, Elizabeth Whiteside ⁶, Robert Baldassano ^1 2, Jonathan Markowitz ^6 7, Amanda B Muir ^1 2

Author information

• ¹Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
• ²Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
• ³Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
• ⁴Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
• ⁵Division of Pediatric Research, Greenville Hospital System Children's Hospital, Greenville, SC 29605, USA.
• ⁶Department of Pediatrics, University of South Carolina School of Medicine-Greenville, Greenville, SC 29605, USA.
• ⁷Division of Gastroenterology and Nutrition, Greenville Hospital System Children's Hospital, Greenville, SC 29605, USA.

Abstract

Background & aims: The incidence and prevalence of eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are rising with similar patterns. Co-occurrence of both diseases in the same patient has been increasingly reported. We sought to examine the pediatric population with both EoE and IBD to better understand the epidemiology and clinical implications of this overlap.

Methods: We conducted a retrospective case-control study at two tertiary care children's hospitals. Subjects with both EoE and IBD were identified and compared to randomly-selected controls with EoE and IBD alone in terms of: demographics, atopic conditions, IBD classification, location and phenotype of Crohn's disease (CD), IBD medications, endoscopic findings, and histopathology. Descriptive statistics summarized the data.

Results: Sixty-seven subjects with dual-diagnosis were identified across both institutions. The prevalence of IBD in the EoE population was 2.2% and EoE in IBD was 1.5%. Subjects with both diseases were more likely to have IgE-mediated food allergy compared to IBD alone (36% vs. 7%, p < 0.001). Subjects with CD-EoE were less likely to have perianal disease than CD alone (2% vs 20%, p = 0.004). There was no difference in fibrostenotic EoE between the dual-diagnosis group and EoE alone. Treatment with a TNF-alpha inhibitor (anti-TNF) for management of preexisting IBD was protective against development of EoE with a relative risk of 0.314 (95% CI 0.159-0.619).

Conclusions: This is a unique population in whom the underlying pathway leading to dual-diagnosis is unclear. Concomitant atopic conditions, especially IgE-mediated food allergy, and medication exposures, particularly anti-TNFs, may help predict likelihood of developing dual-diagnosis.