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Early Life Exposures as Risk Factors for Pediatric Eosinophilic Esophagitis

Jensen, Elizabeth T.*; Kappelman, Michael D.; Kim, Hannah P.; Ringel-Kulka, Tamar§; Dellon, Evan S.

Journal of Pediatric Gastroenterology and Nutrition: July 2013 - Volume 57 - Issue 1 - p 67–71
doi: 10.1097/MPG.0b013e318290d15a
Original Articles: Gastroenterology

Objectives: Few etiologic studies of eosinophilic esophagitis (EoE) have been conducted. Early life exposures have been shown to predispose to other allergic disease, but their role has not been assessed in EoE. The present study sought to explore early life exposures as possible risk factors for developing EoE in the pediatric population.

Methods: This was a 2-phase case-control study conducted at the University of North Carolina. The first phase consisted of survey development for early life exposures via cognitive interview. In the second phase, a telephone-based questionnaire was administered to cases with EoE (n = 31) and 2 sets of controls, patients with gastroesophageal reflux disease, and siblings of nonsyndromic cleft lip/palate patients (n = 26 in each). Different controls were explored to identify controls reflective of the source population of the cases. Siblings of cleft lip/palate patients were identified as the more suitable control population. Odds ratios were calculated to evaluate the association between early life exposures and the development of pediatric EoE.

Results: Early life exposures were associated with increased odds of developing pediatric-onset EoE. Antibiotic use in infancy was associated with 6 times the odds of having EoE (95% confidence interval 1.7–20.8). Cesarean delivery, preterm birth, and formula-only or mixed (infant formula and breast milk) feeding also have trends toward increased odds for developing EoE.

Conclusions: A number of early life exposures may be associated with the development of EoE. These are potentially modifiable risk factors that if confirmed would have implications for improved understanding of EoE pathogenesis and disease prevention.

*Department of Epidemiology, Gillings School of Global Public Health

Department of Pediatrics, Division of Gastroenterology and Hepatology

Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine

§Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Address correspondence and reprint requests to Elizabeth T. Jensen, MPH, Department of Epidemiology, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435 (e-mail:

Received 5 December, 2012

Accepted 5 March, 2013

This article has been developed as a Journal CME Activity by NASPGHAN. Visit to view instructions, documentation, and the complete necessary steps to receive CME credit for reading this article.

This study was financially supported by the University Research Council Small Grant Program and a grant from the Doris Duke Charitable Foundation.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,