Perinatal Environmental Risks for Eosinophilic Esophagitis: A Systemic Review and Meta-Analysis

Area of Science:

• Gastroenterology
• Pediatrics
• Environmental Health

Background:

• Eosinophilic esophagitis (EoE) is an allergic inflammatory disease of the esophagus.
• Limited data exists on the association between EoE and environmental risk factors.
• Perinatal factors are potential environmental influences on EoE development.

Purpose of the Study:

• To determine potential associations between perinatal risk factors and eosinophilic esophagitis (EoE).
• To synthesize existing evidence through a meta-analysis of relevant studies.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane databases up to December 12th, 2023.
• Inclusion of case-control or cohort studies assessing perinatal environmental factors within the first year of life and their association with EoE.
• Meta-analysis using a random-effects model to estimate pooled risk ratios (RR) with 95% confidence intervals (CI).

Main Results:

• Six studies (2,087 EoE cases, 6,786 controls) were analyzed.
• Increased risk of EoE associated with infant antibiotic use (RR 1.30, 95% CI: 1.11-1.52), cesarean section (RR 1.22, 95% CI: 1.10-1.34), preterm birth (RR 1.52, 95% CI: 1.14-2.04), and NICU admission (RR 1.75, 95% CI: 1.41-2.18).
• No significant association found with breastfeeding (RR 1.07, 95% CI: 1.00-1.15).
• Publication bias detected for antibiotic use and cesarean section.

Conclusions:

• A weak association exists between certain perinatal factors (antibiotic use, C-section, preterm birth, NICU admission) and an increased risk of EoE.
• These associations may be indirect rather than causal.
• Further research is warranted to elucidate the relationship between these perinatal factors and EoE development.