Eosinophilic Esophagitis is Associated with an Increased Prevalence of Inflammatory Bowel Disease Maria McIntire, MD, M.H. Saboorian, MD, Robert M. Genta, MD Miraca Life Sciences Research Institute, Irving, TX

Background Methods Results Study Highlights Eosinophilic esophagitis (EoE) is an increasingly prevalent chronic disease We used the Miraca Life Sciences database to extract histopathologic, There were 48,947 unique patients with both esophageal and ileocolonic • Patients with increased esophageal eosinophils, and particularly thought to arise from an allergy/immune-mediated process. demographic, and clinical information from all patients who had simultaneous biopsies; 47,150 (median age 58 years; 64% M) had <15 eos/HPF in the those with >60 eos/HPF are almost twice as likely to have esophageal and ileocolonic biopsies between 1/2008 and 6/2012. esophageal squamous epithelium, and 1,797 had >15 eos/HPF (median age 51 Reports of patients with EoE and concurrent inflammatory bowel disease years; 64% M). concurrent IBD as patients with a normal esophagus. (IBD) have suggested that there might be an association between these two After excluding those with a history or diagnosis of GI cancer or surgery, conditions. patients were stratified in 3 groups according to the numbers of eosinophils The prevalence of ulcerative colitis and Crohn’s disease in each group of • This increase is most evident in patients with UC. per high-power field (eos/HPF) in their esophageal squamous mucosa (<15; patients stratified by numbers of esophageal eosinophils are depicted in However, the possibility of coincidental occurrence cannot be excluded when 15-60; > 60). Figure 2. • A section bias for patients who undergo same-day bidirectional only case reports or small series are analyzed. endoscopy cannot be excluded. However, the possibility that EoE Then, the relative prevalence of ulcerative colitis (UC) and Crohn’s disease (Cro) and IBD share some common immunopathogenetic mechanisms Subtle association, particularly between relatively uncommon conditions, can was calculated for each group of esophageal eosinophilia. only be unveiled by analyzing “big data.” is intriguing and deserves further investigation.

Aims References The purpose of this study was to use a large cohort of patients who 1. Mulder DJ et al. Impact of Crohn Disease on Eosinophilic Esophagitis: Evidence for an had simultaneous upper and lower endoscopy (“same-day bidirectional Altered Th1-Th2 Immune Response. JPGN 2011;53(2):213-215. endoscopy”) to test the hypothesis that inflammatory bowel disease is more 2. Suttor VP et al. Eosinophilic Esophagitis with Crohn’s Disease: A New Association or common in patients with levels of esophageal eosinophilia that meet the Overlapping Immune Mediated Enteropathy? Am J Gastroenterol 2009;104:794-795. histopathologic criteria for the diagnosis of eosinophilic esophagitis (EoE). 3. Furuta GT. Emerging questions regarding eosinophil’s role in the oesophago- gastrointestinal tract. Curr Opin Gastroenterol 2006;22:658-663.

Figure 2 – Prevalence of UC and Crohn’s patients with <15 eos/HPF, and in the two groups with increasing numbers of eos/HPF.

UC was progressively more frequent as the numbers of eos/HPF increased, with an odds ratio of 1.93 (95%CI 1.38 – 2.69; p<.0001) when all patients with Figure 1 – Typical biopsy specimen from the mid-esophagus of a patient with elevated eosinophils were compared to those with <15 eos/HPF. EoE. An increase in Crohn’s disease only occurred in patients with >60 eos/HPF.