Eosinophilic Esophagitis and Autoimmune Thyroid Disease: A Population-Based Matched Cohort Study

Eosinophilic esophagitis (EoE) is an immune-mediated disease typically presenting with esophageal symptoms. Although prior exploratory studies on the autoimmune comorbidity of EoE have indicated a possible association with autoimmune thyroid disease (AITD), this relationship has not been examined in detail.

Using the nationwide ESPRESSO cohort consisting of data from all 28 pathology departments in Sweden, we identified patients with biopsy-confirmed EoE diagnosed between 2006-2023. Each EoE patient was compared with general-population references matched on sex, age, county of residence, and calendar year of diagnosis. A secondary reference group consisted of full siblings of EoE patients. Cox proportional hazard model was used to estimate the hazard ratio (HR) of future AITD, whereas a logistic regression model was used to estimate the odds ratio (OR) of prior AITD.

During follow-up, 70/5801 EoE patients developed AITD (incidence rate, 2.14/1000 person-years) compared to 271/27,407 references (1.74/1000 person-years), corresponding to an HR of 1.18 (95% CI, 0.91-1.54). Compared to sibling comparators, the HR was 1.27 (0.84-1.94). The prevalence of prior AITD was 3.9% in EoE, compared with 3.0% in references, corresponding to an OR of 1.29 (1.10-1.49). Notably, in childhood-onset EoE, the HR of future AITD was 2.53 (1.18-5.45) and the OR of prior AITD was 4.71 (2.34-9.43).

EoE was associated with prior AITD, but not with future AITD. Childhood-onset EoE was however associated with both prior and future AITD. Physicians diagnosing EoE should be observant of symptoms indicative of AITD, especially in childhood-onset EoE.