Esophageal eosinophilia not part of pediatric celiac disease

Last Updated: 2017-05-03

By David Douglas

NEW YORK (Reuters Health) - Eosinophilic eosinophilia (EE) appears not to be a manifestation of celiac disease (CD) in children. The two conditions should thus be treated separately, according to Israeli researchers.

"For many years eosinophils, one of the immune cells which mediates allergy, have been described as part of celiac disease in some patients, however these pre-dated the description of eosinophilic esophagitis (EoE)," Dr. Noam Zevit told Reuters Health by email.

"What we found when we studied (such) patients and followed them over time," he added, "is that overall, eosinophils in the esophagus do not appear to be part of celiac disease, but rather, patients with celiac who are found to have eosinophils actually have two different conditions."

In an April 12 online paper in Archives of Disease in Childhood, Dr. Zevit of Schneider Children’s Medical Center of Israel, Petach Tikva, and colleagues write, "A diagnosis of EoE currently mandates the presence of symptoms, eosinophil-predominant esophageal inflammation and lack of response to high-dose proton pump inhibitors."

When one of these criteria is not met, the term eosinophilic eosinophilia (EE) is used to describe the condition.

To gain further information, the team reviewed and compared medical records from 17 children with CD and EE, 46 with EoE, 302 with isolated CD and 247 with epigastric pain.

Patients with CD and EE tended to present with CD-associated symptoms and 63% later developed typical EoE symptoms. Only 21% of patients with combined disease had EE that resolved with a gluten-free diet. After proton-pump treatment, a further 21% had normalization of EE. The remainder required EoE-specific treatment.

Overall, continued Dr. Zevit, "In most of these combined patients, each of the conditions has its own course, and each needs to be addressed separately. In fact, looking at the patient characteristics, we also noted that patients with the combined disease carry personal and family backgrounds that are also a mix of both conditions (celiac patients often have autoimmunity while EoE patients often have other allergic conditions such as asthma, eczema, and allergic rhinitis)."

"Awareness of this combined condition," he added, "will allow patients to be followed properly by their gastroenterologists, be warned of signs of activity of EoE which will allow early interventions and treatment as these become necessary."

"We are still studying the implications of esophageal eosinophils in asymptomatic individuals and the best timing to initiate treatment,” Dr. Zevit said, “but even if treatment is deferred for patients with celiac and esophageal eosinophils, the knowledge that both conditions are present will allow for earlier awareness of symptomatic deterioration."

Commenting by email, gastroenterologist Dr. Rinaldo Pellicano of Molinette Hospital, Turin, Italy, told Reuters Health, "This article is interesting because it highlights the possibility of the coexistence of these two entities. Since several extraintestinal manifestations have been attributed to CD, correctly the authors reported that EoE is a separate entity."

Dr. Pellicano continued, "The key elements of this study are that all 'alterations' in the esophagus should be analyzed by biopsy and that eosinophilia should be considered."

Because of EE, he concluded, "some CD patients with epigastric pain not responsive to a gluten-free diet" could benefit from treatment with proton pump inhibitors.

SOURCE: http://bit.ly/2oxTVjn

Arch Dis Child 2017.