Esophagus to Small Intestine
Am J Gastroenterol. 2022;117(7):1046–55
Individuals with eosinophilic esophagitis are at greater risk of later psychiatric disorder
Introduction: Several gastrointestinal and allergic diseases have been linked to psychiatric disease, but there are limited data on psychiatric disease in eosinophilic esophagitis (EoE). The aim of the present study was to evaluate the association between EoE and later psychiatric disorders.
Methods: This was a population-based nationwide cohort study. Individuals with EoE diagnosed during 1989 and 2017 in Sweden (n = 1458) were identified through the ESPRESSO histopathology cohort that represents all gastrointestinal biopsy reports in Sweden’s 28 pathology departments. Individuals with EoE were matched with up to 5 reference individuals on sex, age, county, and calendar year (n = 6436). Cox proportional hazard modeling estimated adjusted hazard ratios (HRs). In a secondary analysis, individuals with EoE were compared with their siblings to adjust for intrafamilial confounding.
Results: The median age at EoE diagnosis was 39 years, and 76% of the enrolled individuals with EoE were male. During a median follow-up of 4 years, 106 individuals with EoE (15.96/1000 person-years) developed a psychiatric disorder compared with 331 reference individuals (10.93/1000 person-years), corresponding to an HR of 1.50 (95% confidence interval [CI]: 1.20–1.87). The increased risk was seen in the first 5 years of follow-up, but not thereafter. The highest relative risks were seen in individuals diagnosed with EoE in childhood. Compared with siblings, individuals with EoE were at an increased risk of psychiatric disease (HR = 1.62; 95% CI: 1.14–2.31). EoE was linked to mood disorders, anxiety disorder, and attention-deficit hyperactivity disorder.
Discussion: Individuals with eosinophilic esophagitis may be at greater risk of psychiatric disease than their siblings and the general population. This risk needs to be considered in clinical care to detect, prevent, and treat comorbidity.