Occurrence and Clinical Impact of Eosinophilic Esophagitis in a Large Cohort of Children With Inflammatory Bowel Disease

Marina Aloi; Giulia D'Arcangelo; Danilo Rossetti; Simone Bucherini; Enrico Felici; Claudio Romano; Massimo Martinelli; Valeria Dipasquale; Paolo Lionetti; Salvatore Oliva

doi:10.1093/ibd/izac172

Occurrence and Clinical Impact of Eosinophilic Esophagitis in a Large Cohort of Children With Inflammatory Bowel Disease

Inflamm Bowel Dis. 2023 Jul 5;29(7):1057-1064. doi: 10.1093/ibd/izac172.

Affiliations

¹ Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy.
² Pediatric and Pediatric Emergency Unit, "U. Bosio" Center for Pediatric Digestive Diseases, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy.
³ Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi'', University of Messina, 98124 Messina, Italy.
⁴ Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Napoli, Italy.
⁵ Gastroenterology and Nutrition Unit, Meyer children's Hospital, Department Neurofarba, University of Florence, Florence, Italy.

PMID: 35942651
DOI: 10.1093/ibd/izac172

Abstract

Background: Scarce data have investigated the association between pediatric inflammatory bowel disease (IBD) and eosinophilic esophagitis (EoE). We, therefore, aimed to describe the epidemiology and the possible peculiar phenotype and natural history of such an association.

Methods: Case-control study is based on the Italian Society for Pediatric Gastroenterology (SIGENP) national registry. All children with a combined diagnosis of IBD and EoE were included. The overall prevalence and incidence in 2 periods, 2009 to 2015, and 2016 to 2021, were calculated. Cases were matched with IBD only and EoE only patients in a 1:3:3 ratio. Phenotype and outcomes (courses of steroids, risk of complications, surgery, treatment escalation, and hospitalization) were compared between groups.

Results: Eleven patients (age 11.2 ± 2.8 years, Males 91%) with EoE-IBD out of 3090 patients with IBD were identified, resulting in an overall prevalence of 0.35% and an incidence of 0.18% for 2009 to 2015 and 0.45% for 2016 to 2021. Treatment escalation rates for IBD were significantly higher in patients with IBD compared with EoE-IBD at 12- and 24-month follow-up (0% vs 30%, P = .04; and 9% vs 45.5%, P = .03, respectively). Furthermore, patients with IBD were at a significantly higher risk of hospitalization than both EoE-IBD and EoE patients (log rank P < .001). We found no significant differences in major outcomes related to the EoE course in EoE-IBD patients compared with EoE ones.

Conclusions: The incidence and prevalence of EoE in children with IBD are low, although the incidence seems to be rising in recent years. Having EoE appears to be associated with a milder IBD disease course, whereas having IBD does not seem to affect the natural history of EoE. More data are needed to better define the phenotype of such association.

Keywords: Crohn’s disease; children; eosinophilic esophagitis; incidence; inflammatory bowel disease; prevalence; ulcerative colitis.

Plain language summary

We investigated the association between pediatric inflammatory bowel disease (IBD) and eosinophilic esophagitis (EoE). Our results showed that having an EoE might be associated with a milder IBD disease course, but larger cohort analyses are needed to confirm such result.

MeSH terms

Case-Control Studies
Eosinophilic Esophagitis* / complications
Eosinophilic Esophagitis* / epidemiology
Humans
Inflammatory Bowel Diseases* / complications
Inflammatory Bowel Diseases* / epidemiology
Male