Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database

Evan S. Dellon, Anne F. Peery, Nicholas J. Shaheen, Douglas R. Morgan, Jennifer M. Hurrell, Richard H. Lash, Robert M. Genta

Research output: Contribution to journalArticle

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Abstract

Background & Aims: Eosinophilic esophagitis (EoE) is of increasing prevalence and believed to result from allergic processes. Helicobacter pylori has been inversely associated with allergic diseases, but there is no known relationship between H pylori, EoE, and esophageal eosinophilia. We investigated the association between esophageal eosinophilia and H pylori infection. Methods: We performed a cross-sectional study of data, collected from a US pathology database, on 165,017 patients in the United States who underwent esophageal and gastric biopsies from 2008 through 2010. Patients with and without H pylori on gastric biopsy were compared, and odds of esophageal eosinophilia were determined. Results: From the data analyzed, 56,301 (34.1%) had normal esophageal biopsy specimens, 5767 (3.5%) had esophageal eosinophilia, and 11,170 (6.8%) had H pylori infection. Esophageal eosinophilia was inversely associated with H pylori (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.69-0.87). Compared with patients with normal esophageal biopsy specimens, odds of H pylori were reduced among patients with ≥15 eosinophils per high-power field (eos/hpf) (OR, 0.79; 95% CI, 0.70-0.88), ≥45 eos/hpf (OR, 0.75; 95% CI, 0.61-0.93), ≥75 eos/hpf (OR, 0.72; 95% CI, 0.50-1.03), and ≥90 eos/hpf (OR, 0.52; 95% CI, 0.31-0.87) (P for trend <.001). A similar dose-response trend was observed for increasing clinical suspicion for EoE and decreasing prevalence of H pylori. Additionally, severity of histologic effects of H pylori was inversely associated with esophageal eosinophilia. All trends held in multivariate analysis. Conclusions: In a large cross-sectional analysis, H pylori infection was inversely associated with esophageal eosinophilia. This relationship could have implications for the pathogenesis and epidemiology of EoE.

Original languageEnglish (US)
Pages (from-to)1586-1592
Number of pages7
JournalGastroenterology
Volume141
Issue number5
DOIs
StatePublished - Nov 2011

Fingerprint

Pylorus
Eosinophilia
Helicobacter pylori
Databases
Pathology
Eosinophilic Esophagitis
Eosinophils
Odds Ratio
Confidence Intervals
Biopsy
Stomach
Cross-Sectional Studies
Infection
Epidemiology
Multivariate Analysis

Keywords

  • Epidemiology
  • Esophagus
  • Histologic Analysis
  • Inflammation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database. / Dellon, Evan S.; Peery, Anne F.; Shaheen, Nicholas J.; Morgan, Douglas R.; Hurrell, Jennifer M.; Lash, Richard H.; Genta, Robert M.

In: Gastroenterology, Vol. 141, No. 5, 11.2011, p. 1586-1592.

Research output: Contribution to journalArticle

Dellon, Evan S. ; Peery, Anne F. ; Shaheen, Nicholas J. ; Morgan, Douglas R. ; Hurrell, Jennifer M. ; Lash, Richard H. ; Genta, Robert M. / Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database. In: Gastroenterology. 2011 ; Vol. 141, No. 5. pp. 1586-1592.
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abstract = "Background & Aims: Eosinophilic esophagitis (EoE) is of increasing prevalence and believed to result from allergic processes. Helicobacter pylori has been inversely associated with allergic diseases, but there is no known relationship between H pylori, EoE, and esophageal eosinophilia. We investigated the association between esophageal eosinophilia and H pylori infection. Methods: We performed a cross-sectional study of data, collected from a US pathology database, on 165,017 patients in the United States who underwent esophageal and gastric biopsies from 2008 through 2010. Patients with and without H pylori on gastric biopsy were compared, and odds of esophageal eosinophilia were determined. Results: From the data analyzed, 56,301 (34.1{\%}) had normal esophageal biopsy specimens, 5767 (3.5{\%}) had esophageal eosinophilia, and 11,170 (6.8{\%}) had H pylori infection. Esophageal eosinophilia was inversely associated with H pylori (odds ratio [OR], 0.77; 95{\%} confidence interval [CI], 0.69-0.87). Compared with patients with normal esophageal biopsy specimens, odds of H pylori were reduced among patients with ≥15 eosinophils per high-power field (eos/hpf) (OR, 0.79; 95{\%} CI, 0.70-0.88), ≥45 eos/hpf (OR, 0.75; 95{\%} CI, 0.61-0.93), ≥75 eos/hpf (OR, 0.72; 95{\%} CI, 0.50-1.03), and ≥90 eos/hpf (OR, 0.52; 95{\%} CI, 0.31-0.87) (P for trend <.001). A similar dose-response trend was observed for increasing clinical suspicion for EoE and decreasing prevalence of H pylori. Additionally, severity of histologic effects of H pylori was inversely associated with esophageal eosinophilia. All trends held in multivariate analysis. Conclusions: In a large cross-sectional analysis, H pylori infection was inversely associated with esophageal eosinophilia. This relationship could have implications for the pathogenesis and epidemiology of EoE.",
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T1 - Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database

AU - Dellon, Evan S.

AU - Peery, Anne F.

AU - Shaheen, Nicholas J.

AU - Morgan, Douglas R.

AU - Hurrell, Jennifer M.

AU - Lash, Richard H.

AU - Genta, Robert M.

PY - 2011/11

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N2 - Background & Aims: Eosinophilic esophagitis (EoE) is of increasing prevalence and believed to result from allergic processes. Helicobacter pylori has been inversely associated with allergic diseases, but there is no known relationship between H pylori, EoE, and esophageal eosinophilia. We investigated the association between esophageal eosinophilia and H pylori infection. Methods: We performed a cross-sectional study of data, collected from a US pathology database, on 165,017 patients in the United States who underwent esophageal and gastric biopsies from 2008 through 2010. Patients with and without H pylori on gastric biopsy were compared, and odds of esophageal eosinophilia were determined. Results: From the data analyzed, 56,301 (34.1%) had normal esophageal biopsy specimens, 5767 (3.5%) had esophageal eosinophilia, and 11,170 (6.8%) had H pylori infection. Esophageal eosinophilia was inversely associated with H pylori (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.69-0.87). Compared with patients with normal esophageal biopsy specimens, odds of H pylori were reduced among patients with ≥15 eosinophils per high-power field (eos/hpf) (OR, 0.79; 95% CI, 0.70-0.88), ≥45 eos/hpf (OR, 0.75; 95% CI, 0.61-0.93), ≥75 eos/hpf (OR, 0.72; 95% CI, 0.50-1.03), and ≥90 eos/hpf (OR, 0.52; 95% CI, 0.31-0.87) (P for trend <.001). A similar dose-response trend was observed for increasing clinical suspicion for EoE and decreasing prevalence of H pylori. Additionally, severity of histologic effects of H pylori was inversely associated with esophageal eosinophilia. All trends held in multivariate analysis. Conclusions: In a large cross-sectional analysis, H pylori infection was inversely associated with esophageal eosinophilia. This relationship could have implications for the pathogenesis and epidemiology of EoE.

AB - Background & Aims: Eosinophilic esophagitis (EoE) is of increasing prevalence and believed to result from allergic processes. Helicobacter pylori has been inversely associated with allergic diseases, but there is no known relationship between H pylori, EoE, and esophageal eosinophilia. We investigated the association between esophageal eosinophilia and H pylori infection. Methods: We performed a cross-sectional study of data, collected from a US pathology database, on 165,017 patients in the United States who underwent esophageal and gastric biopsies from 2008 through 2010. Patients with and without H pylori on gastric biopsy were compared, and odds of esophageal eosinophilia were determined. Results: From the data analyzed, 56,301 (34.1%) had normal esophageal biopsy specimens, 5767 (3.5%) had esophageal eosinophilia, and 11,170 (6.8%) had H pylori infection. Esophageal eosinophilia was inversely associated with H pylori (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.69-0.87). Compared with patients with normal esophageal biopsy specimens, odds of H pylori were reduced among patients with ≥15 eosinophils per high-power field (eos/hpf) (OR, 0.79; 95% CI, 0.70-0.88), ≥45 eos/hpf (OR, 0.75; 95% CI, 0.61-0.93), ≥75 eos/hpf (OR, 0.72; 95% CI, 0.50-1.03), and ≥90 eos/hpf (OR, 0.52; 95% CI, 0.31-0.87) (P for trend <.001). A similar dose-response trend was observed for increasing clinical suspicion for EoE and decreasing prevalence of H pylori. Additionally, severity of histologic effects of H pylori was inversely associated with esophageal eosinophilia. All trends held in multivariate analysis. Conclusions: In a large cross-sectional analysis, H pylori infection was inversely associated with esophageal eosinophilia. This relationship could have implications for the pathogenesis and epidemiology of EoE.

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