Proton Pump Inhibitors, Antibiotics, and Atopy Increase the Risk of Eosinophilic Esophagitis in Children with Esophageal Atresia.

ObjectiveTo determine whether proton pump inhibitor (PPI) exposure is associated with an increased risk of developing eosinophilic esophagitis (EoE) in children with esophageal atresia (EA).Study DesignA retrospective chart review of children with EA from January 1, 2005 to December 31, 2020 was undertaken at Sydney Children's Hospital Randwick. Children with EA and EoE (cases) were matched (1:2) to children with only EA (controls) to compare PPI exposure. Other early-life factors such as infantile antibiotic exposure and personal or family history of atopy were also analyzed using simple and multivariable logistic regression.ResultsOf 184 children with EA, 46 (25%) developed EoE during this period. Thirty-eight EoE participants were matched to 76 controls. Children with EoE and EA received PPI for significantly higher durations (p = .018) and at significantly higher cumulative doses (p = .017) than controls. Food allergy (adjusted odds ratio [aOR], 7.317; 95% confidence interval [CI], 2.244-23.742), family history of atopy (aOR, 3.504; 95% CI, 1.268-9.682), and infantile antibiotic exposure (aOR, 1.040; 95% CI, 1.006-1.075) were also significantly associated with an increased risk of developing EoE in the EA cohort.ConclusionsProlonged duration and high cumulative dose of PPI exposure were significantly associated with subsequent EoE development in children with EA. Food allergy, family history of atopy, and infantile antibiotic exposure in EA were also significantly associated with an increased risk of EoE development. Risk factors for eosinophilic esophagitis in children with esophageal atresia. image Children with EA are more likely to develop EoE. Children with EA routinely receive long-term PPI therapy. Early exposure to PPIs has been postulated to increase risk of EoE in the general population.What is New Prolonged proton pump inhibitor (PPI) use and high cumulative PPI exposure are significantly associated with increased risk for the subsequent development of eosinophilic esophagitis (EoE) in children with esophageal atresia (EA). Food allergy, family history of atopy, and infantile antibiotic exposure also demonstrated a significant positive association with development of EoE in children with EA.