P0318 - Eosinophilic Esophagitis Patients With Celiac Disease Have Higher Rates of Comorbid Atopic Conditions

Yeseong Kim, MD¹, Ali El Mokahal, MD², Sherif Saleh, MD², Sara Kamionkowski, DO², Sophie Trujillo, DO², Erika Mengalle, DO², Fahmi Shibli, MD², Ronnie Fass, MD^3
1Temple University School of Medicine, Philadelphia, PA; ²MetroHealth Medical Center, Cleveland, OH; ³Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by eosinophilic infiltration of the esophagus leading to various swallowing symptoms. Comorbid atopic conditions are common in EoE, consistent with its Th2-mediated pathogenesis. Celiac disease (CD) is also an immune and antigen-mediated disease of Th2 dysfunction in individuals sensitive to gluten. While the association between EoE and CD has been described in children, the data in adults are conflicting. We aimed to investigate the association between EoE and CD in adult patients, and determine disease phenotype in patients with coexisting disorders.

Methods: Population-level cohort analysis was performed using the multi-institutional database IBM® Explorys. Adult patients above the age of 18 with a diagnosis of EoE were included. Prevalence data were extracted on patients with both EoE and CD, EoE alone, CD alone, or no disease. Adjusted odds ratios (adjusted for age and sex) were calculated by multivariable logistic regression modeling for coexistence of EoE and CD. Prevalence data for co-morbid atopic conditions including atopic dermatitis, asthma, and allergic rhinitis were collected. Sensitivity analysis was performed to examine any potential associations between CD and other esophageal disorders including Barrett’s esophagus (BE), gastroesophageal reflux disease (GERD), and achalasia.

Results: 43,130 and 135,720 patients were found to have a diagnosis of EoE or CD, respectively, while 870 patients had both diagnoses. Adjusted for age and gender, EoE patients had higher odds of having CD than the general population (OR 6.20, 95% CI 5.45-6.99, p-value < 0.05). Age and male gender were also significant risk factors for EoE, as expected (1.83, 1.79-1.87, p< 0.05) and (1.85, 1.81-1.90, p< 0.05). EoE patients with co-existing CD had higher rates of atopic co-morbidities including asthma (χ2=45.29, df=1, p-value< 0.0001), atopic dermatitis (χ2=11.33, df=1, p-value 0.0008), and allergic rhinitis (χ2=36.36, df=1, p < 0.0001). Sensitivity analyses between CD and GERD (1.18, 0.89-1.43, p 0.47), CD and BE (0.95, 0.84-1.25, p 0.34), as well as CD and achalasia (1.13, 0.94-1.23, p 0.91) revealed no significant associations, as expected, validating the database and our search strategy.

Discussion: EoE confers a higher odds of having CD compared to the general population in adults. Furthermore, EoE patients with coexisting CD have higher rates of concurrent atopic conditions compared to EoE patients without CD.


Figure: Figures showing the odds ratio conferred by CD on EoE development (1) and rates of comorbid atopic conditions in patients with both condtions (2).


Disclosures:
Yeseong Kim indicated no relevant financial relationships.
Ali El Mokahal indicated no relevant financial relationships.
Sherif Saleh indicated no relevant financial relationships.
Sara Kamionkowski indicated no relevant financial relationships.
Sophie Trujillo indicated no relevant financial relationships.
Erika Mengalle indicated no relevant financial relationships.
Fahmi Shibli indicated no relevant financial relationships.
Ronnie Fass: AstraZeneca – Other Financial or Material Support, Speaker. Celexio – Consultant. Daewoong – Consultant. Eisai Pharmaceuticals – Other Financial or Material Support, speaker. GERDcare – Consultant. Ironwood Pharmaceuticals – Grant/Research Support. Johnson & Johnson – Other Financial or Material Support, speaker. Medtronic – Consultant. Neurogastrx – Consultant. Patheon Pharmaceuticals – Consultant. Takeda – Consultant, Other Financial or Material Support, speaker.


Yeseong Kim, MD¹, Ali El Mokahal, MD², Sherif Saleh, MD², Sara Kamionkowski, DO², Sophie Trujillo, DO², Erika Mengalle, DO², Fahmi Shibli, MD², Ronnie Fass, MD³. P0318 - Eosinophilic Esophagitis Patients With Celiac Disease Have Higher Rates of Comorbid Atopic Conditions, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.