Increased Risk of Eosinophilic Esophagitis in Children With IBD

Children with inflammatory bowel disease (IBD) appear to have an increased risk of eosinophilic esophagitis (EoE), but researchers are unsure whether this risk is associated with a shared immunologic pathway or an effect caused by anti-tumor necrosis factor (TNF) therapy. Potential predictive characteristics of EoE following IBD diagnosis in children include weight loss at presentation and the use of anti-TNF therapies, according to study findings presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting held February 26 to March 1, 2021.

While it has been previously established that patients with IBD are at an increased risk for EoE, few research studies have examined the risk factors and clinical characteristics associated with EoE in patients with IBD. In order to breach this research gap, the investigators used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify 464 children with IBD who were seen at the University of Virginia between 2015 and 2020.

According to medical chart review, esophageal eosinophilia, defined as 15 or more eosinophils per high-powered field (eos/hpf), developed in 13 patients following IBD. A total of 7 patients also developed esophageal symptoms (IBD/EoE). Patients with IBD/EoE were matched 6:1 to patients with only EoE, and researchers compared these patients for demographic and clinical characteristics.

The development of EoE occurred after a mean of 17.5 (±6.9 months) following the onset of IBD. Compared with the patients with only EoE, patients with IBD/EoE were less likely to have dysphagia (P =.03) but more likely to present with weight loss (P =.02). Anti-TNF medications were initiated at the time of EoE diagnosis in all 7 children with IBD/EoE.

Limitations of this study included its retrospective design as well as the inclusion of only pediatric patients seen at a single center. Further study is needed to determine a shared immunologic pathway between IBD and EoE.

Reference

Eid R, Mounzer C, Mendoza M, Middleton J, Barnes B, McGowan E. Increased prevalence of eosinophilic esophagitis (EoE) in children with inflammatory bowel disease (IBD). Presented at: the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting 2021; February 26 – March 1, 2021. Abstract 289.