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Role of Environmental Factors in the Development of Pediatric Eosinophilic Esophagitis

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Abstract

Background

Despite accumulating data on the pathogenesis of eosinophilic esophagitis, not much is known about risk factors for the development of the disease. The role of factors such as smoking, breastfeeding, early antibiotic exposure and other factors that have been associated with other allergic diseases has not been well studied in children with eosinophilic esophagitis.

Aim

To explore the role of environmental and medication exposures in the development of pediatric eosinophilic esophagitis.

Methods

We conducted a cross-sectional case–control study, utilizing a parent and child questionnaire and medical chart review. Urine cotinine levels, measured by high-performance liquid chromatography, were obtained as objective evidence for smoking exposure.

Results

One hundred and two children with eosinophilic esophagitis and 167 controls were recruited. The controls were mainly diagnosed with functional gastrointestinal disorders (33 %) and gastroesophageal reflux disease (29 %). Food allergy, specifically for peanuts and tree nuts, and allergy to pollen, tree, and grass were significantly higher among eosinophilic esophagitis children. Smoking exposure, both primary and secondary, was not associated with pediatric eosinophilic esophagitis when compared to controls (odds ratio 0.96, 95 % confidence interval 0.58–1.59). Furthermore, early smoking exposure in the first year of life was higher among controls. Common accepted risk factors for allergy and atopy, such as breastfeeding practices, antibiotics exposure, animals’ exposure, and others, were not found to be associated with eosinophilic esophagitis in our study.

Conclusion

Common risk factors in other allergic and atopic conditions were not found to be associated with eosinophilic esophagitis.

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Abbreviations

EoE:

Eosinophilic esophagitis

FGID:

Functional gastrointestinal disorders

GERD:

Gastroesophageal reflux disease

GI:

Gastrointestinal

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Acknowledgments

We would like to thank Karen J. Goodman, PhD, and Hsiu-Ju Chang, MSc, Department of Medicine, University of Alberta, for help with the statistics and Amr Abdel-Radi, University of Alberta, and Ronda Danchuk of Women and Children’s Research Institute for help with data collection. We thank Dr Justine Turner for her invaluable suggestions and comments on the manuscript.

Conflict of interest

MS was funded through the Stollery Children’s Hospital Foundation and Alberta Innovates Health Solutions postgraduate fellowship. AL was supported by a summer-student grant by the University of Alberta. HH is a consultant for Sucampo, Janssens, and Abbvie, holds a grant from Janssens, and received fund from Actavis for educational events. None is directly related to this study. For the remaining authors, none were declared. This study was funded by the Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada.

Ethical Standard

This study was approved by the University of Alberta Research Ethics Board (Pro00028193). All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

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Authors and Affiliations

  1. Pediatric GI and Nutrition, Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy (ECHA), 4th Floor, Room 4-579, 11405 - 87th Avenue, Edmonton, AB, T6G 1C9, Canada

    Mordechai Slae, Rabin Persad, Aldrich Jing-Tao Leung & Hien Quoc Huynh

  2. Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-142H Katz Group Centre, 87 Ave and 114 St, Edmonton, AB, T6G 2J7, Canada

    Raniah Gabr & Dion Brocks

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  1. Mordechai Slae
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Correspondence to Hien Quoc Huynh.

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Slae, M., Persad, R., Leung, A.JT. et al. Role of Environmental Factors in the Development of Pediatric Eosinophilic Esophagitis. Dig Dis Sci 60, 3364–3372 (2015). https://doi.org/10.1007/s10620-015-3740-7

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  • DOI: https://doi.org/10.1007/s10620-015-3740-7

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