TC Tang et al. JPGN 2024;78:1317–1328. Proton pump inhibitors, antibiotics, and atopy increase the risk of eosinophilic esophagitis in children with esophageal atresia
In this retrospective study (2005-2020) with 184 children, key findings:
- Of 184 children with EA, 46 (25%) developed EoE during this period
- Children with EoE and EA received PPI for significantly higher durations (p = .018) and at significantly higher cumulative doses (p = .017) than controls. (Controls were children with EA who did not develop EoE)
- Food allergy (adjusted odds ratio [aOR], 7.317, family history of atopy (aOR, 3.504), and infantile antibiotic exposure (aOR, 1.040) were also significantly associated with an increased risk of developing EoE in the EA cohort
Discussion: “This is congruent with the emerging evidence in the general pediatric population that there is an increased risk of EoE development in individuals who undergo acid suppressive therapy. A possible explanation for these findings is that acid suppressants inhibit gastric parietal cell function and elevate the gastric pH, thereby impairing peptic digestion of dietary allergens, potentiating sensitization, and facilitating the development of allergic diseases like EoE.” Other potential explanations could include PPIs could increase mucosal permeability and/or contribute to dysbiosis.
“Hence, the routine use of PPIs for the first year of life as recommended by the current guidelines may need to be revisited..”
My take: This study shows a clear association of PPIs with development of EoE in this cohort. Due to the study design, it is difficult to be confident regarding causality due to possible selection bias (patients who received PPIs may be those with more predisposition to EoE). Nevertheless, this study suggests that prolonged use of PPIs, even in groups at risk for reflux damage, needs to be carefully considered and possibly directed by objective markers of reflux.
Related blog posts:
- Do Acid Blockers Given to Infants Increase the Risk of Allergic Disease?
- 2018 Pediatric GERD Guidelines
- Unfavorable Trends in Reflux Management of Infants & Update on USNWR Rankings
- Is Reflux Really a Disease in Premature Infants?
- Good Episode of Bowel Sounds on Reflux
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