Eosinophilic Esophagitis and Celiac Disease EP069

Your gastrointestinal tract is approximately 30 feet long, and it runs from your mouth all the way to the anus! We know that celiac disease can impact any part of the digestive tract. But there is another disease that wreaks havoc on the GI tract as well, a condition called eosinophilic esophagitis or EoE.

The Gluten Free RN is explaining the fundamentals of eosinophilic esophagitis, from its characteristic inflammation of the esophagus and elevated eosinophils in the blood to the common symptoms of vomiting and upper abdominal pain. She walks us through the treatment for EoE, an elimination diet or steroid therapy.

Nadine speaks to the research exploring a possible connection between eosinophilic esophagitis and celiac disease, citing a paper that found a higher prevalence of EoE in children with celiac disease than the general population as well as the case study of a woman with both celiac disease and elevated eosinophils in her blood. Listen in for the Gluten Free RN's insight on the best EoE clinics and physicians in the country and learn why further study is needed around EoE and celiac disease!

What's Discussed:

The fundamentals of eosinophilic esophagitis

• Allergic response to dietary antigens
• Causes inflammation of esophagus, increased eosinophils in blood

The benefits of unsedated transnasal endoscopy for children with EoE

• Monitors esophageal mucosa without sedation
• Safer, faster and less costly

Some common symptoms of eosinophilic esophagitis

• Vomiting, difficulty swallowing, food stuck in throat
• Chest pain, heartburn, upper abdominal pain

The condition of achalasia

• Muscles of esophagus don't work appropriately
• Causes spasms or constriction

The treatment for EoE

• Elimination diet (remove wheat, eggs, milk, soy, shellfish and seafood, peanuts and tree nuts)
• Topical or systemic steroids

The potential increased prevalence of EoE in children with celiac disease

• 2015 paper found prevalence of 10.7% (much higher than general population)
• Other research articles argue no increased prevalence of EoE in CD

The case study of a 30-year-old woman with celiac disease and elevated eosinophils

• Presented with abdominal pain and distension, vomiting and frequent bowel movement
• Treated with IV hydrocortisone, but developed steroid induced psychosis

Nadine's insight on the best specialty clinics for EoE in the US

• University of Colorado (Denver School of Medicine)
• Pennsylvania

Dr. Glenn Furuta's insight on the difficulty of diagnosing EoE

• Relatively new disease, tendency to diagnose based on pathology report alone
• Elevated eosinophils also found in GERD, inflammatory bowel disease and celiac disease

Special considerations for pediatric patients with EoE

1. Consultation with dietician
2. Limited exposure to corticosteroids
3. Attention to development of feeding skills
4. Potential psychosocial, behavioral problems

Resources:

'Unsedated Transnasal Esophagoscopy for Monitoring Therapy in Pediatric Eosinophilic Esophagitis' in Gastrointestinal Endoscopy

'Eosinophilic Esophagitis Associated with Celiac Disease in Children' in BMC Research Notes

'Eosinophilic Gastrointestinal Disorder in Coeliac Disease: A Case Report and Review' in Case Reports in Gastrointestinal Medicine

'Eosinophilic Esophagitis in Children and Adults' in Gastroenterology and Hepatology

'The Association Between Celiac Disease and Eosinophilic Esophagitis in Children and Adults' in BMC Gastroenterology

'Eosinophils in Gastrointestinal Disorders' in Immunology and Allergy Clinics of North America

'2013 Update on Celiac Disease and Eosinophilic Esophagitis' in Nutrients

'Eosinophilic Esophagitis: New Insights in Pathogenesis and Therapy' in the World Journal of Gastrointestinal Pharmacology and Therapeutics

'Incidence and Prevalence of Eosinophilic Esophagitis in Children' in the Journal of Pediatric Gastroenterology and Nutrition

'Management of Eosinophilic Esophagitis and Celiac Disease' in Current Opinion in Pharmacology

'Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients with Active Celiac Disease on Biopsy' in Clinical Gastroenterology and Hepatology

'Individuals Affected by Eosinophilic Gastrointestinal Disorders Have Complex Unmet Needs and Frequently Experience Unique Barriers to Care' in Clinics and Research in Hepatology and Gastroenterology

'Eosinophilic Esophagitis and Celiac Disease: A True Association or Coincidence?' in the Journal of Pediatric Gastroenterology and Nutrition

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Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Heal