PEDIATRIC PATIENTS WITH CORMORBID DIAGNOSIS OF EOSINOPHILIC ESOPHAGITIS AND INFLAMMATORY BOWEL DISEASE

The comorbid diagnoses of eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are reported increasingly. Few studies have investigated EoE-IBD co-occurrence in children specifically. We aimed to describe the clinical characteristics, risk factors, and outcomes of disease-specific therapy in patients diagnosed with both EoE and IBD.

We conducted a retrospective, single-center review of patients with EoE-IBD followed in the Pediatric IBD Program at Cedars-Sinai. We collected data from Jan 2008 to Jan 2023 including demographics, clinical characteristics, and endoscopy findings. Descriptive statistics were performed. As a control group for the assessment of atopic risk factors, we compared EoE-IBD patients to a separate cohort of pediatric patients with EoE seen at Cedars-Sinai from January 2019 to December 2023.

We identified 27 patients with EoE-IBD co-occurrence. Follow-up data was available for 24 patients, median (range) follow-up time of 9.4 (3.3-22.6) years. The median (range) age at EoE diagnosis was 12.6 (3.4-22.9) years. The median (range) age at IBD diagnosis was 11.5 (0.7-21.8) years. 14 were diagnosed with IBD first. 11 patients were diagnosed with both EoE and IBD at the same time. 2 were diagnosed with EoE first. IBD diagnoses included Crohn’s disease (n=19), ulcerative colitis (n=3), and indeterminate colitis (n=5). More than half of the EoE-IBD patients had no esophageal symptoms when they were diagnosed with EoE. Median eosinophil counts in esophageal tissue at the time of EoE diagnosis were higher in patients with EoE (p< 0.05). Compared to the control group of EoE patients, EoE-IBD patients appeared less atopic. Anti-TNF therapy was used in 87% (n=13/15) of patients diagnosed with IBD first, 40% (n=4/10) of patients diagnosed with EoE-IBD at the same time, and none of the patients (n=0/2) who were diagnosed with EoE first.

Our data adds to the literature describing EoE-IBD in children. Our cohort shares similar clinical characteristics to those reported in other studies of EoE-IBD. EoE-IBD patients appear less atopic compared to patients with EoE only. Future work needs to further assess the association between anti-TNF therapy and EoE-IBD outcomes.