Previous Infections May Increase Risk of EoE, Study Finds

The study findings suggest that eosinophilic esophagitis (EoE), like other atopic diseases, may be associated with infections.

Prior infections—particularly sepsis and gastrointestinal infections—appear to increase the risk of an eosinophilic esophagitis (EoE) diagnosis, according to a new national case-control cohort study.

The report, based on more than 1500 people in Sweden with EoE, was published in the United European Gastroenterology Journal.

EoE affects people of all ages and is often associated with other allergic diseases. Rates of EoE are increasing worldwide, but it is unclear exactly why, according to the authors.

Other atopic diseases have been linked with previous viral respiratory infections or early antibiotic exposure, the investigators noted. Yet, little attention has been paid to whether such factors affect EoE risk.

“These associations are underexplored in EoE, with just 2 studies describing potential relationships between risk of EoE and environmental factors such as Cesarean delivery and antibiotic use in the first year of life,” the authors wrote.

The new study marks a more robust effort to understand such potential links. The authors used a nationwide database of Swedish EoE cases that were verified by biopsy, and then compared those cases with a cohort of matched controls.

All told, 1587 patients and 7660 controls were included in the study. The cases dated from 2000 to 2017. People in the EoE group were twice as likely to have a previous infection (odds ratio, 2.01; 95% CI, 1.78-2.27).

“Interestingly, we found that having a prior gastrointestinal infection translated to a nearly 3-fold increased risk of EoE, while prior respiratory infections carried almost a 2-fold risk,” the authors wrote. “The strongest risk of EoE development was associated with prior diagnosis of sepsis (over 3-fold risk).”

When the authors compared individuals with EoE with their siblings without EoE, they found the sibling with EoE was 1.57 times as likely to have had a previous infection.

“This is notable as siblings often share a similar health care seeking pattern, but also because a sibling comparison will minimize, though not negate, the impact of genetics and shared early environmental exposures,” they said.

The authors also found that people with multiple infections appeared to have a higher risk of EoE, suggesting a possible dose-related effect, although they said those data need to be interpreted with caution and require further study.

In addition, the investigators wrote that their data suggested antibiotic exposure was associated with an uptick in EoE risk, although they said it is not clear whether the antibiotics themselves conveyed the excess risk or whether the association was a surrogate for infection or microbial dysbiosis.

The authors said their study had limitations, including relatively small numbers of patients in certain subgroups and the possibility that some patients might have already had undiagnosed EoE at the time of their infections.

Nonetheless, the authors said their data suggest that infection history could be an important risk factor in EoE.

“While the pathophysiology of EoE is not fully understood, our data supports a potential role for antecedent infectious triggers in EoE pathogenesis, of which gastrointestinal and more severe infections in particular carry greater risk,” they said.


Uchida AM, Ro G, Garber JJ, Roelstraete B, Ludvigsson JF. Prior hospital-based infection and risk of eosinophilic esophagitis in a Swedish nationwide case-control study. United European Gastroenterol J. Published online October 18, 2022. doi:10.1002/ueg2.12324

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