Helicobacter Pylori Infection Is Associated With a Reduced Risk of Developing Eosinophilic Oesophagitis

U. von Arnim; T. Wex; A. Link; M. Messerschmidt; M. Venerito; S. Miehlke; P. Malfertheiner

Disclosures

Aliment Pharmacol Ther. 2016;43(7):825-830. 

In This Article

Abstract and Introduction

Abstract

Background Eosinophilic oesophagitis (EoE) represents a chronic immune-antigen-mediated allergic disease of the oesophagus of still unknown aetiology. Environmental exposure has been postulated to play a pathogenetic role. Helicobacter pylori (H. pylori) infection has been inversely associated with allergic diseases including atopic dermatitis, asthma and allergic rhinitis and H. pylori may play a protective role in these conditions. Little is known about the relationship between EoE and H. pylori.

Aim To investigate in a case–control study whether H. pylori infection is associated with a reduced risk of developing EoE.

Methods H. pylori infection was evaluated by serology in 58 [11(19%) female, 47 (81%) male, median age: 36.5 years, range 20–72 years] patients with a clinical and histologically proven diagnosis of EoE and 116 age and sex-matched controls (1 case: 2 controls). Antibodies against H. pylori were identified by enzyme-linked immunosorbent assay. Patients with H. pylori-specific IgG ≥30 enzyme immunounits were classified as H. pylori-positive.

Results 3/58 (5.2%) patients with EoE had serological evidence of H. pylori infection (EoE – H. pylori current infection) and 5/58 (8.6%) reported prior eradication therapy for H. pylori infection (EoE – H. pylori former infection). The control group demonstrated significantly higher seroprevalence of H. pylori (37.9%, P < 0.0001) when compared to patients with EoE. EoE was inversely associated with H. pylori infection [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.11–0.50].

Conclusion Helicobacter pylori infection is inversely associated with EoE. Our results may contribute to further understanding the pathogenesis and evolving aetiology of EoE.

Introduction

Eosinophilic oesophagitis (EoE) is a chronic immune/antigen-mediated oesophageal disease characterised clinically by symptoms related to oesophageal dysfunction and histologically by eosinophil-predominant inflammation.[1] Two decades ago, EoE was assumed to be an extremely rare disease, but epidemiologic studies have since confirmed an increasing incidence and prevalence in children, adults and in elderly (>65 years) mainly affecting populations from developed/industrialised countries.[2–6] Depending on study population/design EoE is diagnosed with a prevalence of 0.99% (95% confidence interval, CI 0.7–1.3)[7] to 12% (95% CI 8.5–16.4).[8] A recently published study from a large database in Denmark calculated in an EoE case-finding model an estimated EoE prevalence of 13.8/100 000 persons in 2012 independently from increasing biopsy rates.[9]

Pathogenesis is hypothesised to involve both environmental and genetic factors, particularly food antigens and/or aeroallergens.[10,11] Younger adults with EoE commonly have a personal or family history of co-existing atopies (atopic dermatitis, allergic rhinitis, allergic asthma and atopic eczema),[12] interestingly elderly EoE patients present with a lower prevalence of atopic comorbidities.[2] It is well accepted that EoE is an immune- mediated allergic process[13] and there is also an established potential link between allergy and childhood infection especially with H. pylori.[14,15] Furthermore, a protective role of H. pylori has been attributed in allergic conditions.[16] As clinical and pathophysiological characteristics of EoE resemble allergic asthma, EoE is sometimes referred to as 'asthma of the oesophagus'. We hypothesised that H. pylori infection would be inversely associated with EoE.

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