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Early Life Factors are Associated with Risk for Eosinophilic Esophagitis Diagnosed in Adulthood
AGA Abstracts Tu1101 ASSESSMENT OF PROXIMITY TO SWINE FARMING OPERATIONS AS A RISK FACTOR FOR EOSINOPHILIC ESOPHAGITIS Elizabeth T. Jensen, Kate Hoffman, Cary C. Cotton, Daniel J. Green, Amanda Tapia, Kevin Turner, Robert M. Genta, Evan S. Dellon Background: We have previously shown an association between low population density and eosinophilic esophagitis (EoE), but the reasons for this have not been explored. Largescale animal feeding operations are more common in areas of low population density and have been associated with increased exposure to several potentially immune-modifying compounds, but proximity to these has never been assessed as a risk factor for EoE. Aim: To determine whether residential proximity to permitted swine facilities is associated with increased risk of EoE. Methods: We performed a case-control study of patients who had undergone upper endoscopy and biopsy using two data sources: An EoE database from a tertiary center in North Carolina (NC); and a national pathology database restricted to data obtained in NC. Cases from the tertiary center had EoE as diagnosed per consensus guidelines. Cases from the pathology database had esophageal eosinophilia >15 eos/hpf. Two separate control groups were selected from both data sources: Endoscopy controls without EoE or other esophageal pathology; and, to mimic specialty referral patterns, patients with Barrett's Esophagus (BE). Proximity to and density of permitted swine facilities was determined using data obtained from the NC Division of Water Resources, Animal Feedings Branch. Residential addresses of the subjects and swine facility locations were geocoded using ArcGIS. Logistic regression was used to estimate the crude and adjusted (adjusted for age, sex, race, and population density) odds of EoE relative to exposure. Results: In the tertiary center analysis (n=401 cases; 1,852 endoscopy-based controls; 432 BE controls), there was a positive association between proximity to a permitted swine facility (<1 mile distance) and odds of EoE (aOR 2.56; 95% CI: 1.33-4.95) for endoscopy-based controls, but there was no significant association when using BE controls (aOR: 1.80; 95% CI: 0.59-5.48; Table). Density of farms (>10 farms/census tract) was also positively associated with EoE (aOR: 2.76; 95% CI: 1.305.84) for endoscopy-based controls, but the association was attenuated with BE controls (aOR: 2.27; 95% CI: 0.96-5.33). In contrast, in the pathology database analysis (n=904 cases; 4,074 endoscopy-based controls; 1,853 BE controls) there was no consistent evidence of an association between proximity to or density of farms relative to EoE (Table). Conclusions: Despite increased risk of EoE in rural areas, proximity to large scale swine farms does not appear to be an explanation. Associations in the single-center analyses were attenuated with a BE control group, suggesting these observations may be attributable to referral bias. The same associations were not able to be replicated in a different data source.
Tu1100 EARLY LIFE FACTORS ARE ASSOCIATED WITH RISK FOR EOSINOPHILIC ESOPHAGITIS DIAGNOSED IN ADULTHOOD Elizabeth T. Jensen, Olivia Shaheen, Nathaniel T. Koutlas, Audrey O. Chang, Lisa J. Martin, Marc E. Rothenberg, John A. Baron, Evan S. Dellon Background: The initial etiologic triggers in eosinophilic esophagitis (EoE) are unknown. Previous studies have shown that select early life exposures are associated with an increased risk of pediatric eosinophilic esophagitis (EoE). However, it is unknown if early life factors are associated with increased risk of EoE diagnosed in adults. Aim: To assess the association between early life risk factors and development of EoE in adulthood. Methods: We performed a case-control study at University of North Carolina. Participants were adults (≥18 years) who had previously been enrolled in a prospective study of EoE diagnosis during the time of a clinically indicated upper endoscopy. Cases of EoE were diagnosed as per consensus guidelines and after a PPI trial. Controls did not meet these diagnostic criteria. Patients with PPI-responsive esophageal eosinophilia were excluded. Subjects were contacted to complete our Early Life Exposure Questionnaire, which was developed in our prior study of early life factors and EoE. We focused on key 4 exposures: any antibiotics taken during the first year of life, Cesarean delivery, preterm delivery (≤37 weeks gestation), and NICU admission. We also contacted the mothers of subjects to supplement the subject questionnaire data and to evaluate the potential for reporting bias. We used generalized linear models (logit link, binomial distribution) to calculate the odds of EoE given each exposure and calculated 95% confidence intervals. Agreement between subjects and their mothers was calculated using Cohen's Kappa. Results: A total of 40 EoE cases (mean age 33 years; 53% male; 96% white; baseline peak eosinophil count 81 eos/hpf) and 40 non-EoE controls (mean age 43; 38% male; 80% white; baseline 1 eos/hpf) were contacted to complete the survey. Across each of the early life exposures examined, we observed a positive association between exposure and development of EoE in adulthood (antibiotics in infancy, OR: 4.64; 95% CI: 1.63-13.2; C-section, OR: 3.08; 95% CI: 0.75-12.6; preterm delivery, OR: 2.92; 95% CI: 0.71-12.0; NICU admission, OR: 4.00; 95% CI: 1.01-15.9) (Figure). Results were unchanged after adjusting for age. Moderate to strong agreement in survey responses was observed for the 54 subject-mother pairs examined (antibiotics, K=0.44, p=0.02; C-section, K=1.0, p<0.001; preterm delivery, K=0.80, p<0.001; NICU, K=0.76, p<0.001). Conclusions: Early life factors, including antibiotics in infancy, Cesarean section, preterm delivery, and NICU admission are associated with increased risk of EoE diagnosed in adulthood. These results are similar to previously reported associations in children, indicate persistent effects of early life exposures into adulthood, and merit additional study to confirm relationships and investigate possible conserved pathogenic mechanisms.
S-861
AGA Abstracts
Tu1100 EARLY LIFE FACTORS ARE ASSOCIATED WITH RISK FOR EOSINOPHILIC ESOPHAGITIS DIAGNOSED IN ADULTHOOD Elizabeth T. Jensen, Olivia Shaheen, Nathaniel T. Koutlas, Audrey O. Chang, Lisa J. Martin, Marc E. Rothenberg, John A. Baron, Evan S. Dellon Background: The initial etiologic triggers in eosinophilic esophagitis (EoE) are unknown. Previous studies have shown that select early life exposures are associated with an increased risk of pediatric eosinophilic esophagitis (EoE). However, it is unknown if early life factors are associated with increased risk of EoE diagnosed in adults. Aim: To assess the association between early life risk factors and development of EoE in adulthood. Methods: We performed a case-control study at University of North Carolina. Participants were adults (≥18 years) who had previously been enrolled in a prospective study of EoE diagnosis during the time of a clinically indicated upper endoscopy. Cases of EoE were diagnosed as per consensus guidelines and after a PPI trial. Controls did not meet these diagnostic criteria. Patients with PPI-responsive esophageal eosinophilia were excluded. Subjects were contacted to complete our Early Life Exposure Questionnaire, which was developed in our prior study of early life factors and EoE. We focused on key 4 exposures: any antibiotics taken during the first year of life, Cesarean delivery, preterm delivery (≤37 weeks gestation), and NICU admission. We also contacted the mothers of subjects to supplement the subject questionnaire data and to evaluate the potential for reporting bias. We used generalized linear models (logit link, binomial distribution) to calculate the odds of EoE given each exposure and calculated 95% confidence intervals. Agreement between subjects and their mothers was calculated using Cohen's Kappa. Results: A total of 40 EoE cases (mean age 33 years; 53% male; 96% white; baseline peak eosinophil count 81 eos/hpf) and 40 non-EoE controls (mean age 43; 38% male; 80% white; baseline 1 eos/hpf) were contacted to complete the survey. Across each of the early life exposures examined, we observed a positive association between exposure and development of EoE in adulthood (antibiotics in infancy, OR: 4.64; 95% CI: 1.63-13.2; C-section, OR: 3.08; 95% CI: 0.75-12.6; preterm delivery, OR: 2.92; 95% CI: 0.71-12.0; NICU admission, OR: 4.00; 95% CI: 1.01-15.9) (Figure). Results were unchanged after adjusting for age. Moderate to strong agreement in survey responses was observed for the 54 subject-mother pairs examined (antibiotics, K=0.44, p=0.02; C-section, K=1.0, p<0.001; preterm delivery, K=0.80, p<0.001; NICU, K=0.76, p<0.001). Conclusions: Early life factors, including antibiotics in infancy, Cesarean section, preterm delivery, and NICU admission are associated with increased risk of EoE diagnosed in adulthood. These results are similar to previously reported associations in children, indicate persistent effects of early life exposures into adulthood, and merit additional study to confirm relationships and investigate possible conserved pathogenic mechanisms.
S-861
AGA Abstracts