Question:
Good morning. My 5-year-old son was recently diagnosed with EoE during a gastroscopy performed to investigate coeliac disease. I should mention that he is asymptomatic for both conditions.
On the same day as the gastroscopy, 14 June, he was prescribed PPI treatment for three months. After receiving the histology report on 6 July, which confirmed both conditions, we had a meeting with the medical team regarding coeliac disease only, and they told us to start a gluten-free diet.
From what I understood:
the PPI treatment was prescribed to determine whether my son has PPI-responsive EoE, otherwise it would not be effective as a treatment for EoE symptoms;
EoE is the expression of an allergy whose nature is still unknown in my son’s case.
I therefore wonder whether starting a diet that excludes gluten, and therefore wheat, could confuse the interpretation of the response to therapy. In other words, if the EoE improves, how would we know whether this is because it is PPI-responsive or because the allergen has been removed?
Related questions: should we continue with the treatment? Should we wait before starting the gluten-free diet?
Thank you very much.
Answer:
Due to shared etiopathogenetic mechanisms, EoE and coeliac disease may coexist, and there is scientific evidence showing that a properly followed gluten-free diet alone may also have a therapeutic effect on EoE.
However, there are patients with both coeliac disease and EoE who are asymptomatic but still require additional treatments, beyond the gluten-free diet, in order to achieve histological remission of EoE. These treatments may include PPIs, corticosteroids, or other elimination diets.
It is therefore necessary to follow the recommendations of the medical team managing both conditions, discussing the therapeutic options according to the individual case, and confirming their effectiveness at least six months after starting treatment. This means checking for the disappearance of eosinophils in the esophagus and the restoration of the integrity of the duodenal mucosa.
In any case, a gluten-free diet is essential whenever coeliac disease has been histologically confirmed.
dott.ssa Paola De Angelis, MD (Pediatra- Gastroenterologo, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma)
Please remember that the answers provided are opinions and do not constitute medical advice. They cannot replace a consultation, a medical examination, or the review of the patient’s medical documentation.