Interdisciplinary Department of Medicine, Pediatric Section "B. Trambusti", University of Bari "Aldo Moro", Via Amendola 207, 70126 Bari, Italy.
Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
Nutrients. 2021 Oct 24;13(11):3755. doi: 10.3390/nu13113755.
The association between eosinophilic esophagitis and celiac disease is still controversial and its prevalence is highly variable. We aimed to investigate the prevalence of esophageal eosinophilia and eosinophilic esophagitis in a large group of children with celiac disease, prospectively followed over 11 years.
Prospective observational study performed between 2008 and 2019. Celiac disease diagnosis was based on ESPGHAN criteria. At least four esophageal biopsies were sampled in patients who underwent endoscopy. The presence of at least 15 eosinophils/HPF on esophageal biopsies was considered suggestive of esophageal eosinophilia; at the same time, eosinophilic esophagitis was diagnosed according to the International Consensus Diagnostic Criteria for Eosinophilic Esophagitis.
A total of 465 children (M 42% mean age 7.1 years (range: 1-16)) were diagnosed with celiac disease. Three hundred and seventy patients underwent endoscopy, and esophageal biopsies were available in 313. The prevalence of esophageal eosinophilia in children with celiac disease was 1.6% (95% CI: 0.54-2.9%). Only one child was diagnosed as eosinophilic esophagitis; we calculated a prevalence of 0.3% (95% CI: 0.2-0.5%). The odds ratio for an association between eosinophilic esophagitis and celiac disease was at least 6.5 times higher (95% CI: 0.89-47.7%; = 0.06) than in the general population.
The finding of an increased number of eosinophils (>15/HPF) in celiac patients does not have a clinical implication or warrant intervention, and therefore we do not recommend routine esophageal biopsies unless clinically indicated.
本研究旨在调查一组经过 11 年以上前瞻性随访的乳糜泻患儿中食管嗜酸性粒细胞增多和嗜酸性食管炎的患病率。
这是一项 2008 年至 2019 年进行的前瞻性观察研究。乳糜泻的诊断依据是 ESPGHAN 标准。在接受内镜检查的患者中至少采集 4 处食管活检标本。食管活检中至少有 15 个嗜酸性粒细胞/高倍镜视野（HPF）被认为提示食管嗜酸性粒细胞增多；同时，根据国际嗜酸性食管炎共识诊断标准诊断为嗜酸性食管炎。
共诊断出 465 例（男 42%，平均年龄 7.1 岁[范围：1-16]）乳糜泻患儿。370 例患儿接受了内镜检查，313 例患儿可获取食管活检标本。乳糜泻患儿的食管嗜酸性粒细胞增多患病率为 1.6%（95%可信区间：0.54-2.9%）。仅有 1 例患儿被诊断为嗜酸性食管炎，我们计算出其患病率为 0.3%（95%可信区间：0.2-0.5%）。嗜酸性食管炎与乳糜泻之间的关联的比值比至少高 6.5 倍（95%可信区间：0.89-47.7%；P=0.06）。
在乳糜泻患者中发现嗜酸性粒细胞增多（>15/HPF）并不具有临床意义或需要干预，因此我们不建议常规进行食管活检，除非有临床指征。
