Proton pump inhibitors, antibiotics, and atopy increase the risk of eosinophilic esophagitis in children with esophageal atresia
Tiffany C. Tang
School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
Search for more papers by this authorSteven T. Leach
School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
Search for more papers by this authorCorresponding Author
Usha Krishnan
School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
Department of Pediatric Gastroenterology, Sydney Children's Hospital Randwick, Sydney, Australia
Correspondence Usha Krishnan, Department of Pediatric Gastroenterology, Sydney Children's Hospital Randwick, High St, Randwick, NSW 2031, Australia.
Email: [email protected]
Search for more papers by this authorTiffany C. Tang
School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
Search for more papers by this authorSteven T. Leach
School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
Search for more papers by this authorCorresponding Author
Usha Krishnan
School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
Department of Pediatric Gastroenterology, Sydney Children's Hospital Randwick, Sydney, Australia
Correspondence Usha Krishnan, Department of Pediatric Gastroenterology, Sydney Children's Hospital Randwick, High St, Randwick, NSW 2031, Australia.
Email: [email protected]
Search for more papers by this authorAbstract
Objective
To determine whether proton pump inhibitor (PPI) exposure is associated with an increased risk of developing eosinophilic esophagitis (EoE) in children with esophageal atresia (EA).
Study Design
A retrospective chart review of children with EA from January 1, 2005 to December 31, 2020 was undertaken at Sydney Children's Hospital Randwick. Children with EA and EoE (cases) were matched (1:2) to children with only EA (controls) to compare PPI exposure. Other early-life factors such as infantile antibiotic exposure and personal or family history of atopy were also analyzed using simple and multivariable logistic regression.
Results
Of 184 children with EA, 46 (25%) developed EoE during this period. Thirty-eight EoE participants were matched to 76 controls. Children with EoE and EA received PPI for significantly higher durations (p = .018) and at significantly higher cumulative doses (p = .017) than controls. Food allergy (adjusted odds ratio [aOR], 7.317; 95% confidence interval [CI], 2.244–23.742), family history of atopy (aOR, 3.504; 95% CI, 1.268–9.682), and infantile antibiotic exposure (aOR, 1.040; 95% CI, 1.006–1.075) were also significantly associated with an increased risk of developing EoE in the EA cohort.
Conclusions
Prolonged duration and high cumulative dose of PPI exposure were significantly associated with subsequent EoE development in children with EA. Food allergy, family history of atopy, and infantile antibiotic exposure in EA were also significantly associated with an increased risk of EoE development.
Graphical Abstract
Risk factors for eosinophilic esophagitis in children with esophageal atresia.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
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