Association Between Eosinophilic Esophagitis, Atopic Disease, and IBD in Children

In pediatric patients with inflammatory bowel disease (IBD), the prevalence of eosinophilic esophagitis (EoE) and esophageal eosinophilia (EE) is higher than that reported in the general population, and is strongly associated with the presence of atopic disease. These were among the findings of research presented at the American College of Allergy, Asthma, and Immunology (ACAAI) Annual Scientific Meeting, held in New Orleans, LA, November 4 to 8, 2021.

A retrospective study was conducted among children with IBD who were seen at the University of Virginia between October 2015 and June 2020.  The investigators sought to explore rates of EE and EoE in children with IBD, as well as to identify those features that are associated with comorbid disease. ICD-10 codes were used to identify individuals with IBD, with the diagnosis confirmed via chart review. All patients who had undergone an upper endoscopic examination were identified. In these individuals, EoE was defined as at least 15 eosinophils per high-power field (eos/hpf) and EE as the presence of at least 1 eos/hpf. Risk factors for EoE and EE were identified via use of multivariable logistic regression.

A total of 541 pediatric participants with IBD were evaluated, with 51 of them being diagnosed with EE as well and 7 of them having EoE. Children with EE and EoE, compared with those with IBD only, were significantly more likely to be of nonHispanic White racial background (IBD, P =.015; EoE, P =.01), to be male (EoE, P =.015), and to have at least 1 atopic disease (P <.001 for both). When potential confounders were considered, both IBD mixed phenotype and atopic disorders were both significantly associated with an increased risk for the development of EE (P =.024 and P ≤.001, respectively).

The researchers concluded that among atopic patients with IBD who have symptoms of esophageal dysfunction, suspicion for EoE should be high and assessment should be carried out.

Reference

Eid R, Mounzer C, Mendoza M, Middleton J, Barnes B, McGowan E. Determinants of     esophageal eosinophilia and eosinophilic esophagitis in children with inflammatory bowel disease. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA. Abstract A079.