Early Life Factors are Associated with Risk for Eosinophilic Esophagitis Diagnosed in Adulthood

Jensen, Elizabeth T.; Shaheen, Olivia; Koutlas, Nathaniel T.; Chang, Amy; Martin, Lisa J.; Rothenberg, Marc E.; Baron, John A.; Dellon, Evan S.

doi:10.1016/s0016-5085(17)32960-8

Cited by 3 publications

(6 citation statements)

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“…Four of these included pediatric patients only, 74–77 one study examined adult patients. 78 With the exception of one study, which observed only a weak inverse association between postnatal, environmental tobacco smoke exposure and EoE in the pediatric population, 76 all four other studies, conducted at three different centers, identified associations between early life factors and the development of EoE. 74, 75, 77, 78 For the pediatric studies, while not all of the studies examined the same factors and differences in the associations were observed between studies, factors identified were consistent with those factors that have been demonstrated to alter microbiota colonization in the gut, including supplemented breastfeeding or formula feeding (possible protective effect for breastfeeding observed), NICU admission, antibiotic use in infancy, cesarean delivery, ownership of a furred pet in the home in infancy (protective association observed), and infant use of acid suppressants (further described below).…”

Section: Early Life Factors and Eoementioning

confidence: 99%

Environmental factors and eosinophilic esophagitis

Jensen

Dellon

2018

Journal of Allergy and Clinical Immunology

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The incidence and prevalence of eosinophilic esophagitis (EoE) have markedly increased over the past 2 decades, outpacing increased detection of the disease. Although genetic susceptibility markers for EoE have begun to be elucidated, the rate at which EoE has increased in incidence suggests environmental factors predominate. Despite many advances in understanding of the pathogenesis of EoE, the cause of EoE is unknown. This article reviews the emerging data related to environmental risk factors for EoE. Many of these environmental factors are rooted in the theoretical framework of the hygiene hypothesis, specifically mediation of disease development through dysbiosis. Other hypotheses are based on associations that have been observed in studies of non-EoE allergic disease. We describe the evidence that early-life exposures, including antibiotic use, acid suppression, and cesarean delivery, can increase the risk of disease. We also describe the evidence that infectious agents, such as Helicobacter pylori, are inversely associated with disease. Current evidence on geographic risk factors, such as population density, climate zone, and seasonality, is reviewed. We also describe behavioral factors that have been evaluated. Limitations of the existing research are discussed, and recommendations for future areas of research, including assessment of gene-environment interaction, are presented.

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Section: Early Life Factors and Eoementioning

confidence: 99%

Environmental factors and eosinophilic esophagitis

Jensen

Dellon

2018

Journal of Allergy and Clinical Immunology

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“…Several studies have suggested early‐life exposures such as pre‐term birth, 23 neonatal intensive care unit (NICU) admission, 23 acid suppression, 24,25 antibiotic use, 25–27 Caesarean delivery, 26,27 and material smoking 25 all pose an increased risk for developing EoE. In contrast, having furred pets 25 or experiencing Helicobacter pylori infection may decrease the risk of developing EoE. One hypothesis is that these early‐life exposures may influence microbiota colonisation or constitution, such as in the case of Helicobacter pylori exposure, and affect EoE development 28–31 .…”

Section: Epidemiologymentioning

confidence: 99%

“…In contrast, having furred pets 25 or experiencing Helicobacter pylori infection may decrease the risk of developing EoE. One hypothesis is that these early-life exposures may influence microbiota colonisation or constitution, such as in the case of Helicobacter pylori exposure, and affect EoE development.…”

Section: Eosinophilic Oesophagitismentioning

confidence: 99%

Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases

Low,

Dellon

2023

Aliment Pharmacol Ther

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SummaryBackgroundEosinophilic gastrointestinal diseases (EGIDs) are chronic, immune‐mediated disorders characterised clinically by gastrointestinal symptoms and histologically by a pathologic increase in eosinophil‐predominant inflammation in the gastrointestinal tract, in the absence of secondary causes of eosinophilia.AimsTo highlight emerging insights and research efforts into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis (EoE) and non‐EoE EGIDs, and discuss key remaining knowledge gaps.MethodsWe selected and reviewed original research, retrospective studies, case series, randomised controlled trials, and meta‐analyses.ResultsStandardised nomenclature classifies EGIDs as EoE, eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). Incidence and prevalence of EoE are rising, emphasising the need to better understand how environmental risk factors and genetic features interact. Advances in understanding EoE pathophysiology have led to clinical trials of targeted therapy and the approval (in the United States) of dupilumab for EoE. Several therapies that are under investigation hope to satisfy both histologic and clinical targets. For non‐EoE EGIDs, efforts are focused on better defining clinical and histopathologic disease determinants and natural history, as well as establishing new therapies.ConclusionsUnmet needs for research are dramatically different for EoE and non‐EoE EGIDs. In EoE, non‐invasive diagnostic tests, clinicopathologic models that determine the risk of disease progression and therapeutic failure, and novel biologic therapies are emerging. In contrast, in non‐EoE EGIDs, epidemiologic trends, diagnostic histopathologic thresholds, and natural history models are still developing for these more rare disorders.

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“…E xclusive human milk (HM) feedings have consistently been shown to improve clinical outcomes in premature infants: these include reduced risks for late-onset sepsis, bronchopulmonary dysplasia, retinopathy of prematurity, and necrotizing enterocolitis, along with improved neurodevelopment (1)(2)(3)(4). As healthcare professionals caring for premature infants, our priorities are to optimize their health, immunity, and growth.…”

Section: Yimin Chenmentioning

confidence: 99%

“…T he increasing incidence of eosinophilic esophagitis (EoE) has generated considerable interest in interrogating possible factors contributing to this rise (1). Although still quite limited, the most developed line of inquiry has focused on examining the relationship between early life factors and development of EoE in the pediatric population and 1 study in adults (2,3). These assessments have demonstrated associations with cesarean delivery and antibiotic use in infancy (3).…”

mentioning

confidence: 99%