TABLE 1.

Clinical, histological and endoscopic findings in children with both celiac disease (CD) and eosinophilic esophagitis (EoE)

Patient	Age, years/sex	Symptoms	Indication for endoscopy	First endoscopy and histology	Treatment	Endoscopy/histology/general results after GFD	Endoscopy/histology after EoE treatment
1	13/male	Dysphagia, impaction, choking on food, abdominal pain, vomiting, slow eater, excessive chewing, and food refusal	Confirmed EoE. CD found incidentally, ATTG 117 U/mL	White exudates and loss of vascular pattern. Mild BCH and 6 Eos/HPF in esophagus. Marsh Score of 3A	GFD	ATTG 12 units/mL and normal duodenal biopsy. Esophageal hypereosinophilia and endoscopic changes remain (48 Eos/HPF)	Endoscopy normalizes under fluticasone (0 Eos/HPF)
2	10/male	Family history of CD. Asymptomatic for CD. Dysphagia noted on review	Confirmed CD, ATTG 220 U/mL	White exudates and vertical furrows. BCH and 33 Eos/HPF in esophagus. Marsh Score of 3A	GFD	Minor residual villous atrophy and intraepithelial lymphocytosis in bulb biopsy only. Esophageal hypereosinophilia and endoscopic changes remain (40 Eos/HPF). Repeat ATTG required	Repeat endoscopy required for fluticasone treatment
3	8/female	Abdominal pain and food refusal, iron deficiency, family history of CD	Confirmed CD, ATTG 310 U/mL	Loss of vascular pattern, vertical furrows and white exudates. BCH and 20 Eos/HPF in esophagus. Marsh score of 3B	GFD	ATTG 9.2 U/mL and normal duodenal biopsy. Esophageal hypereosinophilia, BCH and endoscopic changes remain (50 Eos/HPF)	Endoscopy normalizes under fluticasone (0 Eos/HPF)
4	12/male	Poor growth	Confirmed CD, ATTG 17 U/mL	Normal endoscopy. BCH and 27 Eos/HPF in esophagus. Marsh score 3A	GFD	Improvement in inflammation of duodenum. Complete resolution of esophageal hypereosinophilia (0 Eos/HPF) and BCH	Not on EoE treatment
5	14/female	No symptoms. Family history of CD	Confirmed CD, ATTG 280 U/mL	Normal endoscopy. BCH and 54 Eos/HPF in esophagus. Marsh score 3B	GFD	Noncompliant on GFD and Marsh score 3A. Endoscopic with vertical furrows and loss of vascular pattern (>30 Eos/HPF)	Repeat endoscopy required for fluticasone treatment
6	10/female	Abdominal pain and vomiting; family history of CD	Confirmed CD, ATTG 43 U/mL	Vertical furrows and white exudates with duodenal edema. BCH and 50 Eos/HPF in esophagus. Marsh score 3B	GFD	ATTG of 1.2 U/mL and normal duodenal biopsy. Esophageal hypereosinophilia and endoscopic changes remain (50 Eos/HPF). Still has abdominal pain	Endoscopy normalizes under fluticasone (18 Eos/HPF). Abdominal pain improves slightly
7	8/female	Nocturnal diarrhea, constipation, weight loss and abdominal pain. Family history of CD	Confirm CD, Immunoglobulin A deficient	Loss of vascular pattern, white exudates. BCH, 36 Eos/HPF in esophagus. Marsh score 2	GFD	Normal duodenal biopsy. Persistent EoE changes (45 Eos/HPF). Repeat ATTG required	Endoscopy normalizes (3 Eos/HPF) with budesonide
8*	15/female	Abdominal pain, bloating and slow eater	Confirm CD, ATTG 20 U/mL	Vertical furrows and white exudates. BCH, 22 Eos/HPF in esophagus. Marsh score 3A	GFD and PPI	Normal duodenal biopsy. Resolution of esophageal intraepithelial eosinophil (0 Eos/HPF), yet BCH remains with persistent endoscopic changes without white exudates. Repeat ATTG required	Not on EoE treament
9†	12/male	Dysphagia, food impaction, and vomiting	Confirmed EoE. CD found incidentally on second endoscopy, ATTG 920 U/mL after second endoscopy	Loss of vascular pattern, thickened esophagus, vertical furrows, and concentric rings. BCH and 40 Eos/HPF in esophagus. Duodenum was not examined	Fluticasone	CD disease detected during second endoscopy; therefore, repeat endoscopy required to determine effect of GFD. EoE resolved completely after initial treatment (0 Eos/HPF)	Endoscopy normalizes (0 Eos/HPF) with fluticasone

^*Combination gluten-free diet (GFD) and proton pump inhibitor (PPI) treatment;

^†EoE initial treatment, then GFD; ATTG Antitransglutaminase; BCH Basal cell hyperplasia; CD Celiac disease; Eos Eosinophils; HPF High-powered field