From the Guidelines
The management of eosinophilic esophagitis (EoE) and celiac disease requires distinct approaches, with EoE treatment prioritizing pharmacotherapy, such as proton pump inhibitors or topical corticosteroids, alongside dietary modifications, while celiac disease necessitates strict lifelong gluten elimination. The relationship between EoE and celiac disease is complex, with some patients experiencing coexistence of both conditions due to shared immune-mediated pathophysiology 1. In such cases, treatment becomes more intricate, requiring patients to maintain strict gluten avoidance for celiac disease while potentially eliminating additional food triggers for EoE.
Key Considerations in Management
- Dietary management for EoE involves a step-up approach, starting with a 2-food exclusion diet for at least 8-12 weeks, followed by reintroduction of foods one at a time to identify trigger foods 1.
- Pharmacotherapy for EoE includes proton pump inhibitors and topical corticosteroids, which are effective in inducing and maintaining remission 1.
- Gluten elimination is essential for celiac disease management, with no medications currently approved for primary treatment.
- Monitoring requires separate assessments for celiac disease (serologic testing and intestinal biopsies) and EoE (esophageal biopsies).
Overlap and Shared Pathophysiology
The overlap between EoE and celiac disease likely stems from their shared TH2-mediated immune responses and genetic predispositions. Some patients with EoE may respond to gluten elimination alone, suggesting potential common triggers, though most require more extensive dietary modifications or pharmacologic therapy.
Recommendations
- Combination therapy of pharmacotherapy and dietary modifications should be reserved for selected patients who fail monotherapy and have access to a multiprofessional team, including a dietitian 1.
- Allergy testing is not recommended for guiding dietary elimination in EoE, as it has limited accuracy in identifying specific food triggers 1.
- Support from an experienced dietitian is strongly recommended to mitigate the risks of nutritional deficiencies and to help patients succeed on dietary modifications 1.
Conclusion is not allowed, so the response ends here.
From the Research
Relationship Between Eosinophilic Esophagitis and Celiac Disease
- Eosinophilic esophagitis and celiac disease are two distinct gastrointestinal disorders that may coexist more often than expected 2, 3.
- The prevalence of eosinophilic esophagitis in patients with celiac disease is higher than in the general population, with a reported prevalence of 3.2% to 4.4% 2, 3.
Management and Treatment
- A gluten-free diet is the primary treatment for celiac disease, but its effectiveness in inducing remission of eosinophilic esophagitis is unclear 2, 4.
- Some studies suggest that a gluten-free diet may resolve esophageal eosinophilia in some patients with coexistent celiac disease and eosinophilic esophagitis 4.
- Topical corticosteroid therapy and diet elimination therapy are also used to treat eosinophilic esophagitis, but the optimal treatment approach for patients with coexistent celiac disease is not well established 5.
Diagnostic Considerations
- Routine esophageal biopsies may be warranted when investigating for celiac disease to detect coexistent eosinophilic esophagitis 3.
- Tissue transglutaminase immunoglobulin A antibody (TTG) testing and duodenal biopsy may help diagnose celiac disease in patients with eosinophilic esophagitis 4.
Clinical Implications
- Awareness of the potential coexistence of eosinophilic esophagitis and celiac disease is essential for optimal diagnosis and management of these conditions 2, 3.
- Further studies are needed to elucidate the mechanisms linking eosinophilic esophagitis and celiac disease, and to determine the most effective treatment approaches for patients with coexistent disease 4, 5.