Increased Risk of EoE Linked to Antibiotic and Acid Suppressant Use in Pregnancy and Infancy

Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory disease of the esophagus, the tube leading from the mouth to the stomach. It occurs when a type of white blood cell, the eosinophil, accumulates in the esophagus. This accumulation can cause injury and inflammation to the esophagus and the damage it causes may make eating difficult or uncomfortable, potentially resulting in poor growth, chronic pain, and/or difficulty swallowing.

A Danish cohort study published in JAMA Pediatrics found a link between antibiotic and acid-suppressant use during pregnancy and infancy with the development of EoE later in life.

The authors reported that infants that used antibiotics had a 40% greater risk of developing EoE later in childhood than control subjects, while maternal use during pregnancy resulted in a 50% greater risk.

Infant use of acid suppressants was also associated with an increased risk of developing EoE.

The authors wrote:

Several potential mechanisms may explain our findings. Antibiotics and acid suppressants have been suggested to increase the risk of allergic sensitization, and several reports have linked maternal and infant antibiotic use to the development of other (non-EoE) atopic diseases. Still, it can be difficult to disentangle the temporality of these associations.

Contextualizing our results for acid suppressants is somewhat more difficult. Prematurity increases the likelihood of prophylactic acid suppressant use. When examining the magnitude of risk associated with acid suppressants, we observed the highest magnitude of association among preterm infants. Therefore, prophylactic acid suppressant use might contribute to increased EoE risk.

Said John Russo, MD, of Nationwide Children’s Hospital in Columbus, Ohio to MedPage Today:

There’s clearly a correlation between early antibiotic use and atopic diseases like eosinophilic esophagitis. We need to be judicious in our use of antibiotics especially early in life.

Colleague Rajitha Venkatesh, MD, MPH noted:

Early life has been demonstrated to be the period for colonization of the gut where any changes could have lasting consequences to diversity and relative abundance features in the microbiome.

The researchers compared a registry of 1.4 million children born between 1997 and 2018 with prescription data from the Danish National Prescription Registry for their study. The final analysis included 392 patients with EoE matched by birth year and gender to 3,637 control subjects.

The link between infant and maternal antibiotic use was found to be dose-dependent. For example, infants who were prescribed three or more doses had their risk rise 80%.

The interval with the highest risk of developing EoE was found to be the third trimester of pregnancy to age 6 months for the child

The researchers noted that EoE was more prevalent among children delivered via c-section, born pre-term and admitted to the neonatal intensive care unit.

The authors note the study is small, race and ethnicity data was not available, and they used the filling of prescriptions as a proxy for actual administration.