Antibiotic and Acid Suppressor Exposure Associated with Increased Risk of Eosinophilic Esophagitis in Children

The development of eosinophilic esophagitis (EoE) later in childhood has been linked to antibiotic and acid suppressant exposure during the perinatal period, according to a Danish cohort study. The study found that infants with any antibiotic use had a 40% greater risk of developing EoE compared to controls without such exposure. Additionally, maternal antibiotic use during pregnancy was associated with a 50% increased risk of the child developing EoE. The study also reported that infant use of acid suppression was linked to an increased risk of EoE development.

The researchers suggest that antibiotics and acid suppressants may increase the risk of allergic sensitization, which could contribute to the development of EoE. Previous reports have also linked maternal and infant antibiotic use to the development of other atopic diseases. However, the temporal relationship of these associations is challenging to discern.

The researchers caution that contextualizing the results for acid suppressants is more complex. Prematurity increases the likelihood of prophylactic acid suppressant use, and the study observed the highest magnitude of association among preterm infants. This suggests that prophylactic acid suppressant use could contribute to an increased risk of EoE.

EoE is a chronic condition characterized by the build-up of eosinophils in the esophageal lining, leading to inflammation and difficulty swallowing. While genetic susceptibility markers for EoE have been identified, the heritability of the condition is relatively low compared to other immune-mediated disorders. The study suggests that environmental triggers, such as antibiotic and acid suppressant exposure, play a role in the development of EoE.

The findings of the study highlight the need for judicious use of antibiotics, particularly during early life. The researchers emphasize the importance of considering the potential long-term consequences of antibiotic exposure on the gut microbiome, which undergoes critical colonization during early life. By minimizing the unnecessary use of antibiotics, healthcare providers can reduce the risk of EoE and other atopic diseases.

Healthcare professionals are increasingly recognizing the significance of maternal exposure during pregnancy when assessing a child’s health. By discussing potential issues during pregnancy, including medication use, healthcare providers can gain a more comprehensive understanding of a child’s health history. This information may help fill in the clinical picture and aid in the identification of potential risk factors for EoE and other conditions.

The study utilized a registry of 1.4 million children born between 1997 and 2018, with prescription data from the Danish National Prescription Registry. The analysis included 392 patients with EoE and 3,637 controls. The study found a dose-dependent association between antibiotic use and increased EoE risk. Infants with three or more antibiotic prescriptions had an 80% higher risk of developing EoE. Penicillins and β-lactam antibacterials were the most commonly prescribed class of antibiotics during participant pregnancies. Acid suppression use in infancy was also associated with an increased risk of EoE, particularly among preterm infants.

However, the study has several potential limitations. These include a small case set, missing information on the specific use of prescribed antibiotics, and the reliance on prescription data rather than confirmation of medication administration. Additionally, race and ethnicity were not recorded as part of the patient registry, limiting the assessment of potential disparities in EoE risk.

The Danish cohort study provides evidence linking antibiotic and acid suppressant exposure during the perinatal period to an increased risk of EoE later in childhood. The findings highlight the importance of minimizing unnecessary antibiotic use, particularly during early life, and considering the potential impact on the gut microbiome. Healthcare providers should routinely inquire about maternal exposure during pregnancy to gain insights into potential risk factors for EoE and other conditions. Further research is needed to explore the underlying mechanisms and assess strategies for mitigating the risk of EoE in vulnerable populations.


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