The association between celiac disease and eosinophilic esophagitis in children and adults

Background: An association between eosinophilic esophagitis (EoE)
and celiac disease (CD) has been suggested in the literature. Our
aim was to confirm and quantify the association between these two
diseases. Methods: All patients in a large Canadian city diagnosed
with EoE or CD over a five-year period were identified.
Standardized incidence ratios (SIRs) with 95\% confidence intervals
(CIs) were calculated. Results: Over the five-year study EoE was
diagnosed in 421 patients and CD was diagnosed in 763 patients. The
incidence of EoE ranged from 2.1 to 10.7 cases per 100,000
population. The incidence of CD ranged from 10.4 to 15.7 cases per
100,000 population. Among the EoE cohort, 83 (20\%) cases of EoE
and 245 (32\%) cases of CD were diagnosed in pediatric patients.
The incidence of EoE in the pediatric subpopulation ranged from 3.7
to 6.9 cases per 100,000 population. The incidence of CD in the
pediatric subpopulation ranged from 9.5 to 22.7 cases per 100,000
population. The concomitant diagnosis of both EoE and CD was made
in three patients, all of whom were pediatric males. The SIR for
EoE in the CD cohort was 48.4 (95\% CI = 9.73, 141.41) with a SIR
for CD within the paediatric EoE cohort of 75.05 (95\% CI = 15.08,
219.28). Conclusions: This study confirms the association between
EoE and CD. However, this association may be limited to pediatrics
where the risk of each condition is increased 50 to 75-fold in
patients diagnosed with the alternative condition. The concomitant
diagnosis of these conditions should be considered in pediatric
patients with upper gastrointestinal symptoms.