Esophagus to Small Intestine

United European Gastroenterol J. 2024;12(1):34–43

Uchida AM, Garber JJ, Pyne A, Peterson K, Roelstraete B, Olén O, Halfvarson J, Ludvigsson JF

Eosinophilic esophagitis is associated with increased risk of later inflammatory bowel disease in a nationwide Swedish population cohort

Background: Earlier studies on the possible association between eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) have been contradictory.
Methods: Patients with biopsy-verified EoE diagnosed between 1990 and 2017 in Sweden (n = 1587) were age- and sex-matched with up to 5 general population reference individuals (n = 7808). EoE was defined using pathology reports from all 28 pathology centers in Sweden (the ESPRESSO study). Multivariate Cox regression then estimated hazard ratios (HRs) or future IBD. IBD was defined based on the international classification of disease codes and histopathology codes. In secondary analyses, sibling comparators were used to further reduce potential familial confounding. Additionally, the authors performed logistic regression examining earlier IBD in EoE.
Results: During follow-up until 2020, 16 (0.01%) EoE patients and 21 (0.003%) general population reference individuals diagnosed with IBD, corresponding to a 3.5-fold increased risk of future IBD (adjusted HR [aHR] = 3.56; 95% confidence interval [CI]: 1.79–7.11). EoE was linked to Crohn’s disease (aHR = 3.39; 95% CI: 1.02–9.60) but not to ulcerative colitis (aHR = 1.37; 95% CI: 0.38–4.86). Compared to their siblings, patients with EoE were at a 2.48-fold increased risk of IBD (aHR = 2.48; 95% CI: 0.92–6.70). Earlier IBD was 15 times more likely in EoE patients than in matched reference individuals (odds ratio = 15.39; 95% CI: 7.68–33.59).

Conclusion: In this nationwide cohort study, eosinophilic esophagitis was associated with a 3.5-fold increased risk of later inflammatory bowel disease diagnosis. This risk increase may be due to shared genetic or early environmental risk factors, but also surveillance bias could play a role.

Prof. Dr. J.F. Ludvigsson, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, E-Mail:

DOI: 10.1002/ueg2.12493

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