Author(s): Dellon ES, Peery AF, Shaheen NJ, Morgan DR, Hurrell JM,
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Abstract BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is of increasing prevalence and believed 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 US pathology database, on 165,017 patients in the United States who underwent esophageal and gastric biopsies from 2008 through 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 biopsy specimens, 5767 (3.5\%) had esophageal eosinophilia, and 11,170 (6.8\%) had H pylori infection. Esophageal eosinophilia was inversely associated with H pylori (odds ratio [OR], 0.77; 95\% confidence interval [CI], 0.69-0.87). Compared with patients with normal esophageal biopsy specimens, 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; 95\% CI, 0.61-0.93), ≥ 75 eos/hpf (OR, 0.72; 95\% CI, 0.50-1.03), and ≥ 90 eos/hpf (OR, 0.52; 95\% CI, 0.31-0.87) (P for trend <.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. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
This article was published in Gastroenterology
and referenced in Journal of Hepatology and Gastrointestinal disorders