Early life antibiotic, acid suppressant exposure linked to eosinophilic esophagitis in childhood

Maternal and infant use of antibiotic and acid suppressants appears to contribute to an increased risk of eosinophilic esophagitis (EoE) in a dose-response manner, with the association being strongest when exposed to the medications near the time of delivery, according to a study.

The present case-control study of paediatric EoE included 392 cases and 3,637 sex- and year of birth–matched controls born in Denmark between 1997 and 2018. Researchers collected pathology, prescription, birth, inpatient, and outpatient health registry data.

The entire population had a median age of 11.0 years, and 68.8 percent were boys. Compared with children who had no antibiotic prescriptions filled during infancy, those who had filled any antibiotic prescription had 40-percent greater odds of EoE (adjusted odds ratio [aOR], 1.4, 95 percent confidence interval [CI], 1.1–1.7). The odds were even greater for those with at least three prescriptions filled (aOR, 1.8, 95 percent CI, 1.3–2.5).

Additionally, frequency of maternal antibiotic use was associated with EoE (1 prescription: aOR, 1.4, 95 percent CI, 1.0–1.8; ≥3 prescriptions: aOR, 2.1, 95 percent CI, 1.4–3.2). The odds were greatest when antibiotics were used in the third trimester and in the first 6 months from birth.

Any acid suppressant use in infancy showed an association with EoE as well (aOR, 15.9, 95 percent CI, 9.1–27.7). Similar results were obtained when EoE cases were restricted to those diagnosed at 5 years or older (aOR, 11.6, 95 percent CI, 5.5–24.8). Regarding maternal use, at least three prescriptions contributed to greater odds of EoE in the offspring (aOR, 5.1, 95 percent CI, 1.8–14.8).