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Pediatric Celiac Disease and Eosinophilic Esophagitis

Outcome of Dietary Therapy

Patton, Tiffany*; Chugh, Ankur; Padhye, Leena; DeGeeter, Catherine§; Guandalini, Stefano*

Journal of Pediatric Gastroenterology and Nutrition: March 26, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002343
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Objective: The coexistence of celiac disease (CeD) and eosinophilic esophagitis (EoE) in pediatric patients has been increasingly recognized. In the current study, we have aimed to assess the outcomes of therapeutic dietary interventions in a cohort of pediatric patients with CeD and EoE.

Methods: Pediatric patient records obtained from the University of Chicago Celiac Center Database from August 2008 to July 2013 were reviewed. Information was collected on patients with concomitant CeD and EoE regarding age, gender, dates of diagnoses, presenting symptoms, length of symptoms prior to diagnosis, familial and personal atopic history, dietary therapy, and esophageal histologic response to dietary therapy.

Results: A total of 350 records of CeD patients were reviewed. 22 (6.3%) had a confirmed diagnosis of CeD and EoE, 17 had repeat biopsies. 4/17 (23.5%) had resolution of esophageal eosinophilia on an exclusive gluten-free diet, 10/17 (59%) required additional eliminations to show histologic resolution, 1/17 (6%) hadn’t reached histological remission, and 2/17 (12%) were lost to follow up. Success rates of single food reintroductions were: soy 5/5 (100%), eggs 3/5 (60%), dairy 3/7 (43%), nuts 2/4 (50%), and fish 2/4 (50%).

Conclusions: To our knowledge, this is the largest pediatric study to assess the histologic outcome of EoE-associated esophageal eosinophilia in response to dietary management of pediatric patients with concomitant CeD and EoE. We demonstrate that soy is well tolerated in this cohort, and suggest that reintroducing this food first, or trialing a soy-inclusive elimination diet is a viable strategy.

*Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Comer Children's Hospital, University of Chicago Medical Center, Chicago, Illinois

Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI

Division of Allergy and Immunology, Rush University Medical Center, Chicago, IL

§Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Stead Family Children's Hospital, University of Iowa, Iowa City, IA.

Address correspondence and reprint requests to Tiffany Patton, MD, University of Chicago, Comer Children's Hospital, 5839 S. Maryland Ave, MC 4065, Chicago, IL 60637 (e-mail: tiffany.patton@uchospitals.edu).

Received 29 August, 2018

Accepted 4 March, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

Conflicts of Interest and Source of Funding: None declared. There were no sources of pharmaceutical or industrial support utilized for this study. No funding was received for this project.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,