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Open Access Highly Accessed Research article

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

Michael J Stewart12, Eldon Shaffer1, Stephan J Urbanski3, Paul L Beck1 and Martin A Storr14*

Author Affiliations

1 Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada

2 Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada

3 Department of Pathology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada

4 Division of Gastroenterology, University of Munich, Munich, Germany

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BMC Gastroenterology 2013, 13:96  doi:10.1186/1471-230X-13-96

Published: 30 May 2013

Abstract

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.

Keywords:
Celiac disease; Eosinophilic esophagitis; Endoscopy; Incidence; Epidemiology; Standardized incidence ratios