P1849 - Effect of Concurrent Esophageal Eosinophilia and IBD on Treatment Management

Jason DuBroff, MD, MPH, Ann Flynn, MD, Kathryn Peterson, MD, MSCI
University of Utah School of Medicine, Salt Lake City, UT

Introduction: The association between esophageal eosinophilia (EE) and inflammatory bowel disease (IBD) has only recently been explored. The two diseases share characteristics including T-cell mediated inflammation and inflammatory/fibrostenotic disease phenotypes. However, unlike IBD, limited data suggest that anti-TNF therapy is not effective in EE. The study’s aim was to describe disease characteristics among patients with concurrent EE and IBD (described here as EE/IBD or concurrent disease). We hypothesized that patients with concurrent disease would be less likely to respond to anti-TNF therapies and have more severe EE manifesting as fibrostenotic disease.

Methods: A retrospective case control study was conducted from 2017–2020. Patients were included if they had evidence of EE in pathology specimens ( >15 eosinophils per HPF in distal/proximal esophagus) and/or established IBD. 24 cases of concurrent disease were identified. Patients with isolated IBD or EE were matched 2:1 for gender and age as controls. IBD covariates are listed in table 1. EE characteristics extracted included treatment response (PPI, swallowed steroids, dietary eliminations), diagnosis of asthma, eczema, sinusitis, food allergies, endoscopic reference scores (EREFS), IgE levels, peripheral eosinophilia, and peak eosinophils per HPF. Significant associations were determined using χ2 and Fisher’s exact test. Differences in between group means were analyzed using Student’s t test.

Results: IBD preceded EE diagnosis on average by 4.1 years. Most IBD patients had exposure to anti-TNF agents (56.9%), but EE/IBD (n=11) was more likely to respond to anti-TNF therapy (χ2=10.65, p < 0.01). EE/IBD had more segmental ulcerative colitis (Fisher’s exact, p= 0.04) and eczema (χ2=5.36, p =0.02) than isolated disease, while fibrostenotic EE was less likely to be present in EE/IBD (Fisher’s exact, p=0.01). Mean EREFS score was lower among patients with concurrent disease (2.82 vs 1.70, p=0.01) in comparison to those without.

Discussion: Although EE has not been thought of as anti-TNF responsive, its presence does not appear to influence IBD responsiveness to anti-TNF medication. Additionally, patients with EE/IBD did not demonstrate increased esophageal fibrostenosis, which may reflect earlier endoscopic exploration and detection of EE. This study comprises the largest cohort of patients with confirmed IBD/EE to date and underscores a need for further research of these two intestinal diseases.


Disclosures:


Jason DuBroff, MD, MPH, Ann Flynn, MD, Kathryn Peterson, MD, MSCI. P1849 - Effect of Concurrent Esophageal Eosinophilia and IBD on Treatment Management, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.