Adult Patients with Eosinophilic Esophagitis Do Not Show an Increased Frequency of the HLA-DQ2/DQ8 Genotypes Predisposing to Celiac Disease

Lucendo, Alfredo J.; Arias, Ángel; Pérez-Martínez, Isabel; López-Vázquez, Antonio; Ontañón, Jesús; González-Castillo, Sonia; Rezende, Livia C. De; Rodrigo, Luı́s

doi:10.1007/s10620-010-1383-2

Cited by 33 publications

(30 citation statements)

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“…24 Similarly, a study by Lucendo and colleagues did not find increased HLA DQ2 and DQ8 (implicated in patients with celiac disease) in subjects with EoE when compared to controls. 35 Thus, the literature on this topic has been contradictory and confusing, likely because of variable study designs, inclusion criteria, and comparator groups, as well as relatively small sample sizes. It is not surprising that a recent systematic review examining the association between EoE and celiac disease found no clear association between the two conditions and concluded that there was a lack of robust studies for summarizing the realtionship.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy

Jensen

Eluri

Lebwohl

et al. 2015

Clinical Gastroenterology and Hepatology

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Background and Aims The possible association between eosinophilic esophagitis (EoE) and celiac disease (CD) is controversial as prior results have been contradictory. We aimed to determine the relationship between EoE and CD among patients with concomitant esophageal and duodenal biopsies. Methods We conducted a cross-sectional study in a U.S. national pathology database, using data from January 2009 and June 2012. Our primary case definition was defined by the presence of esophageal eosinophilia with ≥ 15 eosinophils per high-power field. The crude and adjusted (for age and sex) odds of esophageal eosinophilia for patients with active CD were compared to those without CD. Sensitivity analyses were performed using more stringent case definitions and by estimating the associations between CD and reflux esophagitis, and CD and Barrett's esophagus (BE). Results Of 292,621 patients in the source population, 88,517 with both esophageal and duodenal biopsies were studied. 4,101 (4.6%) met criteria for EoE and 1,203 (1.4%) met criteria for CD. Odds of EoE were 26% higher in patients with CD than patients without CD (aOR: 1.26, 95% confidence interval [CI]: 0.98 – 1.60). The magnitude of association varied according to EoE case definition (Table 3), but all definitions showed a weak, positive association between the two conditions. There was no association between CD and reflux esophagitis (aOR 0.95, 95% CI: 0.85 – 1.07) or BE (aOR 0.89, 95% CI: 0.69 – 1.14) and CD. Conclusions There is a weak increase in EoE in patients with CD. This association strengthened with increasingly stringent definitions of EoE, and was not observed for other esophageal conditions. In patients with CD, concomitant EoE should be considered in the correct clinical setting.

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Section: Discussionmentioning

confidence: 99%

Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy

Jensen

Eluri

Lebwohl

et al. 2015

Clinical Gastroenterology and Hepatology

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“…In another Australian study published in 2010 [24], the prevalence of esophageal eosinophilia in children with celiac disease who had concurrent esophageal biopsies was 8.2% (10 of 121), 60% males, 30% had normal-appearing esophageal mucosa at endoscopy; children who had undergone repeated endoscopic examinations showed recovery of duodenal mucosa but no resolution of esophageal eosinophilia on a gluten-free diet alone. The association of celiac and eosinophilic esophagitis may not be a true association but a matter of biased enrollment in the above studies: regarding HLA DQ2 and/or DQ8, a study [25] showed that these alleles were not present in eosinophilic esophagitis at a greater rate than in healthy controls. But a recent study [26] demonstrated, a clear association between celiac disease and eosinophilic esophagitis in both pediatric and adult populations: the standardized incidence ratio of eosinophilic esophagitis in patients with celiac disease was 16.0 (95% CI, 8.7–25.5).…”

Section: Resultsmentioning

confidence: 99%

2013 Update on Celiac Disease and Eosinophilic Esophagitis

et al. 2013

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Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized by upper gastrointestinal symptoms, absence of gastroesophageal reflux disease and more than 15 eosinophils per high-power field in biopsy specimens. Both celiac disease and eosinophilic esophagitis are caused by aberrant, but distinct, immune responses to ingested antigens and can be responsive to restricted food intake. The aim of this review is to assess whether there is an association between these two pathologies. In the majority of the studies examined, including the studies in pediatric population, the prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. We suggest searching for eosinophilic esophagitis in all children undergoing endoscopy for suspicious celiac disease.

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“…In CD, genetic predisposition is related to the presence of HLADQ2 and, to a lesser extent, to HLADQ8. However, the prevalence of those alleles in patients with EoE does not seem to be higher than in the general population, and no polymorphism suggesting a common genetic basis between EoE and CD was identified yet 10. As for environmental factors, both diseases appear to share a component of aberrant immune response to ingested antigens and a response to dietary restrictions.…”

Section: Discussionmentioning

confidence: 95%

Eosinophilic oesophagitis and coeliac disease: is there an association?

Vaz¹,

Cadilla

Sousa

et al. 2017

BMJ Case Reports

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A 25-year-old man was seen in outpatient clinic for progressive solid food dysphagia. He was already medicated with a proton pump inhibitor with no improvement. His blood tests showed a slight microcytic anaemia and peripheral eosinophilia. The oesophago-gastro-duodenoscopy showed longitudinal furrows in the distal two-thirds of the oesophagus and a concentric distal stenosis. The biopsies taken showed eosinophilic infiltrates consistent with eosinophilic oesophagitis. There was no improvement with topical fluticasone, so the patient was started on a systemic corticosteroid with resolution of dysphagia and of the oesophageal stenosis. He was kept on topical steroids for symptomatic control. On repeat endoscopy, the duodenal mucosa showed multiple papules that were biopsied. Histology showed features consistent with coeliacdisease. The patient was asymptomatic but there was evidence of iron deficiency anaemia, and so a gluten-free diet was started. Despite only a partial adherence to the diet, the iron deficiency anaemia resolved.

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Adult Patients with Eosinophilic Esophagitis Do Not Show an Increased Frequency of the HLA-DQ2/DQ8 Genotypes Predisposing to Celiac Disease

Abstract: Our work does not allow us to establish a common genetic basis for EoE and CD because an increased frequency of the HLA DQ2 and DQ8 alleles predisposing to CD was not observed in adult EoE patients compared to controls.

Cited by 33 publications

References 24 publications

Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy

Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy

2013 Update on Celiac Disease and Eosinophilic Esophagitis

Eosinophilic oesophagitis and coeliac disease: is there an association?

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