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Inflammatory bowel disease
Original article
Epidemiology and implications of concurrent diagnosis of eosinophilic oesophagitis and IBD based on a prospective population-based analysis
  1. Berkeley N Limketkai1,
  2. Shailja C Shah2,
  3. Ikuo Hirano3,
  4. Emanuelle Bellaguarda3,
  5. Jean-Frederic Colombel4
  1. 1 Division of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  3. 3 Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4 Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Professor Jean-Frederic Colombel, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA; Jean-frederic.colombel{at}mssm.edu

Abstract

Objective Eosinophilic oesophagitis (EoO) and IBD are immune-mediated diseases of the gastrointestinal tract with possible overlapping pathogenic mechanisms. Our aim was to define the epidemiology and clinical implications of concurrent EoO and IBD diagnoses.

Design We conducted a prospective cohort analysis using the Truven MarketScan database (2009–2016) to estimate the incidence and prevalence of EoO in patients with Crohn’s disease (CD) or UC and vice versa. Cox proportional hazards and Kaplan-Meier methods were used to estimate the risk of EoO-related or IBD-related complications among patients with concurrent diagnoses.

Results Among 134 013 536 individuals, the incidence of EoO, CD and UC were 23.1, 51.2 and 55.2 per 100 000 person-years, respectively. The risk of EoO was higher among patients with CD (incidence rate ratio [IRR] 5.4, p<0.01; prevalence ratio (PR) 7.8, p<0.01) or UC (IRR 3.5, p<0.01; PR 5.0, p<0.01), while the risk of IBD was higher among patients with EoO (CD: IRR 5.7, p<0.01; PR 7.6, p<0.01; UC: IRR 3.4, p<0.01; PR 4.9, p<0.01) versus individuals without either diagnosis. Concurrent diagnosis of EoO and IBD was associated with greater composite risk of IBD-related complications (CD: adjusted HR (aHR) 1.09, p=0.01; UC: aHR 1.10, p=0.04) but lower composite risk of EoO-related complications (aHR 0.59; p<0.01).

Conclusion Based on a population-based prospective cohort analysis, the risk of EoO is significantly higher among patients with IBD and vice versa. Concurrent diagnoses might modify the risk of IBD-related and EoO-related complications. Studies defining the mechanisms underlying these observations are needed.

  • inflammatory bowel disease
  • epidemiology
  • oesophagitis

https://doi.org/10.1136/gutjnl-2018-318074

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    Footnotes

    • BNL and SCS contributed equally.

    • Contributors BNL participated in the study concept and design, data analysis, data interpretation, drafting of the manuscript, critical revision and final approval of the manuscript. SCS and IH participated in the study design, data interpretation, critical revision and final approval of the manuscript. EB participated in the study concept and design, data interpretation, critical revision and final approval of the manuscript. J-FC participated in the study concept and design, data interpretation, critical revision and final approval of the manuscript. J-FC provided study supervision.

    • Funding Access to the Truven Health MarketScan Commercial Database was provided by the Stanford Center for Population Health Sciences (PHS) Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and internal Stanford funding.

    • Competing interests IH received consulting fees and research support from Adare, Allakos, Celgene, Regeneron and Shire. J-FC received research grants from Abbvie, Janssen and Takeda; received payments for lectures from Abbvie, Amgen, Ferring, Shire and Takeda; received consulting fees from Abbvie, Amgen, Boehringer Ingelheim, Celgene, Celltrion, Enterome, Ferring, Genentech, Janssen, Eli Lilly, Mediummune, Merck, Novartis, Pfizer, Protagonist, Sandoz, Second Genome, Seres, Shire, Takeda, Theradiag and Theravance; and holds stock options in Intestinal Biotech Development and Genfit.

    • Ethics approval The study protocol was reviewed and deemed exempt by the Institutional Review Board of Stanford University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.