Hommeida Salim, Alsawas Mouaz, Murad Mohammad H, Katzka David A, Grothe Rayna M, Absah Imad
*Division of Pediatric Gastroenterology and Hepatology†Division of Preventive Medicine, Mayo Clinic College of Medicine, Rochester, MN‡Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN§Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN.
J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):58-63. doi: 10.1097/MPG.0000000000001499.
The association between celiac disease (CD) and eosinophilic esophagitis (EoE) has been the focus of multiple studies with variable results. Both diseases are immune mediated, and dietary triggers play a role in their pathogenesis.
The aim of the study was to analyze the risk of EoE in children with CD, assess the magnitude of association between CD and EoE in children, and report the characteristics and outcomes of children with both conditions.
We conducted a retrospective study of the Mayo Clinic Electronic medical records between January 1, 1998 and December 31, 2015. Systematic review and meta-analysis of multiple databases was conducted to include studies reporting on the same association. Random-effects model was used to report pooled odds ratio (OR) and 95% confidence interval (CI).
In this cohort study, of 10,201 children who underwent at least 1 endoscopy, 595 had EoE, and 546 had CD. The risk of having EoE was not increased in children with CD compared to those without CD (OR, 0.29; 95% CI, 0.154-0.545). Nine of 10 children improved with gluten-free diet, topical glucocorticosteroid, and/or elimination diet. One child lost to follow-up.Meta-analysis of 5 studies showed similar results (OR, 0.525; 95% CI, 0.364-0.797). A total of 45 cases in the literature had both CD and EoE (mean age, 10 years; 64% boys; majority presenting with abdominal pain, vomiting, and diarrhea).
Based on our cohort and the observational data, the diagnosis of CD in children is not associated with increased risk of EoE.
乳糜泻（CD）与嗜酸性食管炎（EoE）之间的关联一直是多项研究的重点，但结果不一。这两种疾病均由免疫介导，饮食诱因在其发病机制中起作用。
本研究旨在分析CD患儿发生EoE的风险，评估儿童CD与EoE之间的关联程度，并报告同时患有这两种疾病的儿童的特征和结局。
我们对梅奥诊所1998年1月1日至2015年12月31日的电子病历进行了回顾性研究。对多个数据库进行了系统评价和荟萃分析，以纳入报告相同关联的研究。采用随机效应模型报告合并比值比（OR）和95%置信区间（CI）。
在这项队列研究中，10201名至少接受过1次内镜检查的儿童中，595名患有EoE，546名患有CD。与未患CD的儿童相比，患CD的儿童发生EoE的风险并未增加（OR，0.29；95%CI，0.154 - 0.545）。10名儿童中有9名通过无麸质饮食、局部糖皮质激素和/或排除饮食得到改善。1名儿童失访。对5项研究的荟萃分析显示了类似结果（OR，0.525；95%CI，0.364 - 0.797）。文献中共有45例同时患有CD和EoE（平均年龄10岁；64%为男孩；多数表现为腹痛、呕吐和腹泻）。
基于我们的队列研究和观察数据，儿童CD的诊断与EoE风险增加无关。
