Esophagus to Small Intestine
United European Gastroenterol J. 2024;12(10):1378-1387
Risk of cancer diagnosis in patients with eosinophilic esophagitis using a nationwide Swedish population cohort
Background: Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus. Chronic inflammation has been linked to cancer development. The authors aimed to study the potential association between EoE and later cancer diagnosis.
Methods: In this nationwide population-based cohort study, the authors identified 1580 individuals with EoE diagnosed between 1990–2017 through Sweden’s 28 pathology departments. Up to 5 general population reference individuals were matched on age and sex (n = 7533). A Cox regression analysis estimated adjusted hazard ratios (aHRs) for cancer up until December 31, 2020. To reduce potential intrafamilial confounding, the authors also compared EoE individuals with their unaffected siblings.
Results: During a median follow-up of 7 years, 47 individuals with EoE (3.9/1000 person-years) developed cancer versus 183 (3.2/1000 person-years) reference individuals. This corresponded to a non-significant aHR of 1.11 (95% confidence interval [CI]: 0.80–1.53). Incidence rates were independent of budesonide and proton-pump inhibitor use. Individuals with EoE however did have an increased risk of esophageal cancer where 2 EoE versus 1 reference individual were diagnosed (aHR = 25.20; 95% CI: 2.28–278.80), and also Barrett’s esophagus risk was also increased in EoE (HR = 18.18; 95% CI: 6.75–48.95). Non-esophageal gastrointestinal (GI) cancer occurred in 11 EoE versus 24 reference individuals: aHR = 2.03 (95% CI: 0.99–4.18). The authors found no increased risk of cancers from the skin (EoE n = 10), lung (n = 0), breast (n = 4), or blood (n = 0). Sibling analyses supported these findings.
Conclusion: The authors did not find any overall association between eosinophilic esophagitis (EoE) and cancer development. EoE was associated with esophageal cancer, but this was very rare with wide confidence interval and few cases therefore they urge caution with generalization of these findings.
DOI: 10.1002/ueg2.12713