Impact of smoking, alcohol consumption, and NSAID use on risk for and phenotypes of eosinophilic esophagitis

Abstract

There are few data exploring modifiable risk factors for eosinophilic esophagitis (EoE). We aimed to determine if smoking, alcohol consumption, and nonsteroidal anti-inflammatory drug (NSAID) use were risk factors for EoE, and to assess their impact on EoE phenotypes and treatment outcomes. We performed a case-control study analyzing data collected from a prospective cohort of adults undergoing upper endoscopy for symptoms of esophageal dysfunction. Incident EoE cases were diagnosed via consensus guidelines. Exposure data were collected via standardized patient questionnaire. Follow-up assessments for cases were made after treatment, with histologic response defined as <15 eosinophils per high-power field (eos/hpf). Exposures were compared between EoE cases and controls, among EoE cases with and without fibrostenosis, and among EoE responders and nonresponders. A total of 115 cases and 225 controls were analyzed. Cases were less likely to have ever smoked cigarettes (23% vs. 47%, P < 0.001) or currently use NSAIDs (17% vs. 40%, P < 0.001) compared to controls. These relations persisted after multivariate analysis. Although alcohol use was more common among cases (75% vs. 51%, P < 0.001), the effect was abrogated after multivariate analysis. Smoking, alcohol, and NSAID use were not associated with the fibrostenotic phenotype. There was a trend toward improved histologic response among EoE patients concomitantly using NSAIDs (87% vs. 63%, P = 0.08; aOR 6.97 (95% CI: 0.81-60.3). In conclusion, NSAID and smoking were inversely associated with EoE compared to endoscopy-based controls. Alcohol use was more prevalent in the EoE cases, although not an independent risk factor. Concomitant NSAID use may improve treatment response and is worthy of future study.

Clinical and endoscopic characteristics of eosinophilic esophagitis in Japan: a case-control study

“…It was consistent with the fact that approximately 60%-70% of patients had some history of allergic diseases. Smoking history was lower in the EoE group in our study, which is also supported by a previous study [17]. Although the possible mechanism by which the smoking history is lower in EoE is unclear, it could be postulated that nicotine might affect either mucosal infiltration or function of eosinophils.…”

Environmental factors and eosinophilic esophagitis

“…Current alcohol use was moderately associated with EoE, but the estimate attenuated with adjustment for age, sex, race, education level, smoking, and atopy (aOR: 1.6; 95% CI: 0.8, 3.1). 115 Other potential confounders, specifically factors that could be associated with smoking behaviors and diagnosis of EoE were not assessed.…”

Clinical and Molecular Factors Associated With Histologic Response to Topical Steroid Treatment in Patients With Eosinophilic Esophagitis

“…Clinical data were prospectively collected using standardized case report forms as previously outlined. 15,20,21 Atopic and food allergy history was obtained by self-report. All endoscopic biopsies were obtained per research protocol.…”