Early life factors are associated with risk for eosinophilic esophagitis diagnosed in adulthood

Abstract

SUMMARY Early life exposures have been associated with pediatric eosinophilic esophagitis (EoE), but it is unknown if a similar association is present in adults. We aimed to assess the association between early life risk factors and development of EoE in adulthood. To do this, we conducted a case–control study which was nested within a prospective cohort study of adults undergoing outpatient endoscopy. Cases of EoE were diagnosed per consensus guidelines; controls did not meet these criteria. Subjects and their mothers were contacted to collect information on four key early life exposures: antibiotics taken during the first year of life, Cesarean delivery, preterm delivery (≤37 weeks’ gestation), and neonatal intensive care unit (NICU) admission. We calculated the odds of EoE given in each exposure and assessed agreement between subjects and their mothers. For the 40 cases and 40 controls enrolled, we observed a positive association between each of the early life exposures and development of EoE (antibiotics in infancy, OR = 4.64, 95% CI = 1.63–13.2; Cesarean delivery, OR = 3.08, 95% CI = 0.75–12.6; preterm delivery, OR = 2.92, 95% CI = 0.71–12.0; NICU admission, OR = 4.00, 95% CI = 1.01–15.9). Results were unchanged after adjusting for potential confounders, though only early antibiotic use had CIs that did not cross 1.0. Moderate to strong agreement was observed between 54 subject–mother pairs (antibiotics, K = 0.44, P = 0.02; Cesarean delivery, K = 1.0, P < 0.001; preterm delivery, K = 0.80, P < 0.001; NICU, K = 0.76, P < 0.001). In sum, antibiotics in infancy was significantly associated with increased risk of EoE diagnosed in adulthood, while positive trends were seen with other early life factors such as Cesarean delivery, preterm delivery, and NICU admission. This may indicate persistent effects of early life exposures and merits additional study into conserved pathogenic mechanisms.

Epidemiology of Eosinophilic Esophagitis in Patients with Cystic Fibrosis: A Population-Based 5-Year Study

“…The exact etiology of EoE remains elusive and several factors such as genetic predisposition, disruptions in epithelial barrier function, altered Th2 immunity and various environmental factors have been incriminated in the pathogenesis [ 23 24 ]. In several studies, exposure to antibiotics and PPI during early infancy has been implicated as risk factors for EoE [ 25 26 27 28 ]. Exposure to PPI early in life could lead to EoE by limiting the peptic breakdown of ingested allergens and accompanying increased gastric mucosal permeability could gastric absorption of the undigested food allergens [ 2 ].…”

Eosinophilic esophagitis—established facts and new horizons

“…Current intake of NSAIDs was found to be associated with a decreased risk in EoE [39], whereas prior intake of antibiotics and PPI use in infancy revealed a risk increase of EoE in childhood (aOR 2.3 and 6.05, respectively) [26,27,40].…”

“…Environmental factors may even play a role as early as prior to birth. Maternal fever during pregnancy (adjusted odds ratio, aOR 3.18) as well as preterm labor and c-section (aOR 2.18 and 1.77, respectively) were found to be associated with developing EoE in the future [26,27]. Furthermore, antibiotics in infancy might increase the risk of EoE in adulthood (OR 4.46) [27].…”

Eosinophilic Esophagitis due to Aeroallergens: A Systematic Review and Update

“…The cases of EoE appear to be high in families; studies in twins give more importance to the role of concurrent environmental exposure than to genetic heritability [25,26]. Environmental factors such as maternal fever during pregnancy, Cesarean delivery, and preterm delivery were associated with the development in the future [25,27]. In addition, consumer antibiotics in infancy might increase the risk of EoE in adult age [25,28].…”