Inverse Association of Esophageal Eosinophilia With Helicobacter pylori Based on Analysis of a US Pathology Database

Abstract

Background & Aims Eosinophilic esophagitis (EoE) is of increasing prevalence and thought to result from allergic processes. Helicobacter pylori has been inversely associated with allergic diseases, but there is no known relationship between H. pylori, EoE and esophageal eosinophilia. We investigated the association between esophageal eosinophilia and H. pylori infection. Methods We performed a cross-sectional study of data, collected from a United States pathology database, on 165,017 patients in the US who received esophageal and gastric biopsies from 2008 and 2010. Patients with and without H. pylori on gastric biopsy were compared and odds of esophageal eosinophilia were determined. Results From the data analyzed, 56,301 (34.1%) had normal esophageal biopsies, 5,767 (3.5%) had esophageal eosinophilia, and 11,170 (4.8%) had H. pylori infection. Esophageal eosinophilia was inversely associated with H. pylori (odds ration [OR]: 0.77, 95% confidence interval [CI]: 0.69–0.87). Compared to patients with normal esophageal biopsies, odds of H. pylori were reduced among patients with ≥15 eosinophils per high-power field (eos/hpf) (OR 0.79; 95% CI 0.70–0.88), ≥45 eos/hpf (OR 0.75; 0.61–0.93), ≥75 eos/hpf (OR 0.72; 0.62–0.83), and ≥90 eos/hpf (OR 0.52; 0.31–0.87) (p for trend <0.001). A similar dose-response trend was observed for increasing clinical suspicion for EoE and decreasing prevalence of H pylori. Additionally, severity of histologic effects of H. pylori was inversely associated with esophageal eosinophilia. All trends held in multivariate analysis. Conclusions In a large cross-sectional analysis, H. pylori infection was inversely associated with esophageal eosinophilia. This relationship could have implications for the pathogenesis and epidemiology of EoE.

Eosinophilic Gastroenteritis Complicated with <i>Helicobacter pylori</i> Infection Unresponsive to Eradication Therapy

“…Against this background, a unified opinion regarding the association between H. pylori infection and EG remains elusive. Dellon et al reported that the incidence of eosinophilic esophagitis is increasing along with that of other allergic diseases due to improvements in hygiene, while the frequency of H. pylori infection is decreasing in an inversely proportional relationship (15). In the present case, the degree of eosinophilic infiltration and severity of the patient's symptoms remained unchanged after eradication therapy.…”

Histological Features of Eosinophilic Esophagitis in Children and Adolescents

“…Another group reported 7 (7.8%) H. pylori infected patients among 89 patients with EoE (3) . It seems there is an inverse relationship between H. pylori and EoE, as well as with other allergic conditions (6) .…”

Eosinophilic Esophagitis: A Comprehensive Review

“…Early antibiotic use in infancy may predispose patients to the disease as well as caesarean delivery [20,31,32]. There has also been shown to be an inverse relation with EoE and h pylori infection, with a case sample size of over 5000 adult and pediatric patients showing an odds ratio of 0.79 of EOE among infected individuals [33].…”