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Celiac Disease and Eosinophilic Esophagitis (EoE)

What is Eosinophilic Esophagitis?

Eosinophilic esophagitis (EoE) is an immune condition affecting the esophagus, which is a tube that connects the mouth and stomach. People with EoE (also called allergic esophagitis), have inflammation in the esophagus caused by foods, allergens, or acid reflux. Damaged or inflamed esophageal tissue leads to a variety of symptoms, most often difficulty swallowing. People with EoE often say it feels like the food gets “stuck.”

Symptoms include:

  • Difficulty or inability to swallow
  • Chest pain
  • Regurgitating food
  • Vomiting
  • Abdominal pain
  • In children, failure to thrive (abnormally short, low weight, weight loss)

This is a chronic condition; treatments usually resolve symptoms, but there is no cure. EoE is more common in men than in women. 

What is the Connection Between Celiac Disease and Eosinophilic Esophagitis?

There are multiple studies that suggest an association between celiac disease and EoE.

  • Researchers from the University of Chicago reviewed the records of patients with celiac disease and found that 6.3% of them had also been diagnosed with EoE. Lead author Tiffany Patton said, “Based on our research, we have found that the 1 in every 16 celiac patients also has eosinophilic esophagitis.”
  • A study from 2013 found an association between CD and EoE, and the authors explained that “the risk of each condition is increased 50 to 75-fold in patients diagnosed with the alternative condition.” They also noted that the association may only affect children (as the study was done with a pediatric population).
  • A study from 2015 found “the incidence of EoE in our cohort of children with CD was 10.7%, which is higher than what has been reported for the general population.”

However, a journal commentary from 2017 suggests the connection between CD and EoE may be overblown. “A systematic review of studies showed the prevalence of CD in EoE varied between 0.16% and 57.1%, whereas the prevalence of EoE in CD ranged from 0% to 10.7%. A significant bias exists in favor of short studies reporting positive associations, whereas large cohorts show no support for any relation between CD and EoE.”

The authors concluded by saying, “Although a connection between the 2 disorders seems likely, further studies with [sic] correct definition of EoE are needed with a larger sample size.”

EoE was only clinically recognized in 1993, so research on it is somewhat sparse, but more and more research is published every year.

How is EoE Diagnosed?

There are a variety of tests used to diagnose EoE, including an upper endoscopy with biopsy, blood tests and an esophageal sponge test.

Once EoE is diagnosed, your doctor may order skin prick tests and food patch tests to identify allergens that could cause the reaction.

Throughout the diagnostic process, you may work with allergists, gastroenterologists and pathologists, along with your primary care physician.

How is EoE Treated?

Although there is no cure, there are a variety of treatments that can alleviate symptoms. If your doctor identifies food allergies, you will be asked to cut these foods out of your diet. Wheat and milk are common allergies in those with EoE, along with soy, egg, nuts and fish. The gluten-free diet may help some patients find relief from symptoms.

Other treatments include proton pump inhibitors (PPI), topical steroids, and monoclonal antibodies. There is one FDA-approved medication for EoE, called Dupixent (dupilumab), which uses monoclonal antibodies to inhibit the immune reaction.

In severe cases, esophageal dilation/stretching may be recommended.

Where Can I Learn More?

Think you may have celiac disease?

Symptoms Checklist