A recent prospective case-control study (J Molina-Infante et al. Am J Gastroenterol 2018; 113: 972-9 -thanks to Ben Gold for this reference) examined the potential connection between Helicobacter pylori and eosinophilic GI diseases. They examined 808 individuals (404 cases of eosinophilic esophagitis [EoE], 404 controls). Key findings:
- H pylori prevalence was not different between cases and controls (37% vs. 40%, odds ratio 0.97). The authors conclude that H pylori which has declined in prevalence globally is not inversely associated with EoE as had been suggested in some previous reports
In an associated editorial, (pg 941-4), the authors note that there has been a dramatic increase in atopic diseases over the past 30 years. One hypothesis has suggested that these epidemiologic changes are related to a changing microbiome. This in turn may be related to frequent antibiotic usage. An example of the proliferation of antibiotics: “20-25% of Swedish adults receive an antibiotic prescription annually.”
While H pylori may be a biomarker associated with poor hygiene/less antimicrobial exposure, it does not appear to be directly related to EoE. The authors indicate that until we have a better understanding, “in the meantime attention to healthier diets and minimizing antibiotic exposure may optimize public health in terms of atopic disease risk.”
My take: Since our genetics do not change quickly, the dramatic changes in disease frequency of conditions like EoE and Crohn’s disease must be influenced by environmental exposures. How to lower the risk of these conditions remains uncertain.
Related blog posts: