Recent paper finding an association of eosinophilic esophagitis with anti-TNFs in pediatric IBD patients: https://www.jacionline.org/article/S0091-6749(20)32109-6/fulltext
Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are immune-mediated diseases with some potential intersections in pathogenesis and epidemiology. In a longitudinal analysis of insurance claims data from over 130 million U.S. patients, investigators found a threefold to fivefold increased risk for EoE in patients with Crohn disease or ulcerative colitis compared with individuals without either disease. There was also a threefold to sixfold increased risk for IBD in patients with known EoE compared with individuals without EoE. IBD complications were slightly more common in patients with concurrent EoE, while conversely, patients with EoE were less likely to have complications if they had concurrent IBD. The latter might be explained by the use of immunomodulators (including steroids) in patients with IBD, which would also suppress eosinophils in the esophagus.
Background: The overlap between eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) has not been extensively examined. We aimed to assess the prevalence of esophageal eosinophilia in patients with IBD. Methods: We conducted a retrospective cohort study using diagnostic codes to identify adults with EoE and IBD between 2008 and 2016 at a tertiary care center. Electronic medical records were reviewed to extract clinical, endoscopic, and treatment data. Patients with esophageal eosinophilia and IBD were compared to EoE cases without IBD. Results: Of 621 EoE patients and 4,814 IBD patients identified, 35 had a code for both diseases and 12 were confirmed to have overlapping IBD and esophageal eosinophilia. The prevalence of esophageal eosinophilia in IBD was 12/4814 (0.25%), and the prevalence of confirmed EoE in IBD was 5/4,814 (0.10%). There were no substantial clinical, endoscopic, or histologic differences between EoE patients with and without IBD. IBD was diagnosed before esophageal eosinophilia 92% of the time, with an average time between diagnoses of 9.6 years. Of the IBD patients, 71% were started on biologic anti-tumor necrosis factor-α therapy an average of 7.6 years prior to developing esophageal eosinophilia. Conclusions: The prevalence of esophageal eosinophilia in IBD is 5 times higher than expected in the general population (0.25 vs. 0.05%) and EoE in IBD is 2 times higher than expected (0.10 vs. 0.05%). Upper gastrointestinal (GI) symptoms in patients with IBD should merit evaluation not only for upper GI Crohn’s disease, but also for esophageal eosinophilia.
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