Children who have both celiac disease and an associated allergic inflammatory disorder may not need to permanently remove soy from their diets to reduce scarring in the esophagus, according to new research from the University of Chicago Medicine.
The study, published in the Journal of Pediatric Gastroenterology and Nutrition, examined outcomes of common therapeutic dietary interventions on the microscopic anatomy of children with celiac and eosinophilic esophagitis (EoE).
The research was led by Tiffany Patton, MD, a pediatric gastroenterologist at UChicago Medicine Comer Children’s Hospital.
Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley and rye. About 1 in every 100 children is diagnosed with the condition; and as a result of the intolerance will experience stomach pains, diarrhea, moodiness and even growth problems. There is no known cure and the only treatment is a gluten-free diet.
Eosinophilic esophagitis is an allergic inflammatory disorder that occurs when the white blood cells that are released during an allergic reaction cause inflammation and scarring along the esophagus. Still a rare disorder, only about 1 in 1,500 children suffer from EoE. Patients with EoE may have trouble swallowing, feel nauseous, have acid reflux, stomach pains or growth problems. Treatments include medication and/or dietary restrictions from dairy or wheat.
“Based on our research, we have found that the 1 in every 16 celiac patients also has EoE,” said Patton.
Researchers reviewed 350 patient records – the largest known pediatric study to assess the microscopic outcomes on celiac disease and EoE – from a database maintained by UChicago Medicine’s Celiac Disease Center. In addition to age and sex, the team also noted other symptoms, the length of symptoms before diagnosis, familial and personal immune response history, dietary therapy and esophageal response to dietary therapy on a microscopic level.
“Unexpectedly, we found increasing numbers of celiac disease patients being diagnosed with EoE at the same time, despite not having the typical symptoms of acid reflux, nausea, vomiting or difficulty swallowing,” said Patton. “We questioned whether this type of inflammation within the esophagus was actually EoE or a completely different process related to celiac disease. And while treating them we noticed they responded to dietary eliminations just the same as other EoE patients.”
The research showed reintroducing soy into a child’s diet first was a promising treatment strategy. Of the 350 records, 17 patients had a confirmed diagnosis of both celiac disease and EoE and repeat biopsies. Of those records, 23.5% had resolution of EoE on a gluten-free diet. However, nearly 60% required additional food elimination diets to show a microscopic resolution. About 6% had not reached microscopic resolution. When single-foods were reintroduced to the diet, 100% found success with soy, 60% were successful with reintroducing eggs and 50% with fish.
“We were surprised to see nearly 25% of patients responding to a gluten-free diet alone, which was higher than expected,” said Patton. “Additionally, soy was well tolerated and may not need to be avoided. Overall, most patients definitely improved symptomatically and had less inflammation on the elimination diet.
This study reiterates that a gluten-free diet alone will not consistently affect patients with celiac disease and EoE on a microscopic level. Furthermore, the researchers suggest that a dietary intervention that allows soy can be a strategic therapeutic approach; however, further research is necessary.
The article, Pediatric Celiac Disease and Eosinophilic Esophagitis: Outcome of Dietary Therapy, was published in August 2019. Additional authors include Ankur Chugh, Leena Padhye, Catherine DeGeeter and Stefano Guandalini.
Tiffany J. Patton, MD - Assistant Professor of Pediatrics
Tiffany J. Patton, MD, provides care for children and adolescents with gastrointestinal problems. She has a particular interest in eosinophilic esophagitis, food allergies and intolerances, nutrition, fecal microbiota transplantation and chronic conditions including inflammatory bowel disease (IBD) and celiac disease.
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