Preterm delivery and NICU admission are associated with the development of eosinophilic oesophagitis

A nationwide, population, and registry-based case-control study showed that perinatal factors, specifically preterm delivery and neonatal intensive care unit (NICU) admission, are associated with an increased risk of eosinophilic oesophagitis. The strongest association was seen between the gestational age and the development of eosinophilic oesophagitis.

According to prior studies, early life exposure is a factor that increases the risk of developing eosinophilic oesophagitis yet the results of most of these studies are limited by recall bias. The current study was conducted to investigate the association between a selected number of perinatal factors with the development of eosinophilic oesophagitis, using registry-based data from the nationwide Denmark cohort [1].

In the large, case-control study presented by Dr Kurt Gencer (Aarhus University, Denmark), 393 cases of neonates with eosinophilic oesophagitis and 3,659 age- and sex-matched controls were included. The researchers collected data prospectively from the Danish health and administrative registries from 1997 to 2019. Dr Gencer and his colleagues defined pregnancy complications, mode of delivery, gestational age at delivery, birth weight, and NICU admission as the perinatal factors and assessed the association between these factors and the development of eosinophilic oesophagitis. They also performed an interaction analysis to see whether the association between the NICU admission and the development of eosinophilic oesophagitis is modified by the preterm status.

In all cases, diagnosis of eosinophilic oesophagitis was confirmed by biopsy and other conditions associated with oesophageal eosinophilia were excluded. The strongest association was observed between the gestational age at delivery and eosinophilic oesophagitis (adjusted OR 3.2; 95% CI 1.6‒6.3) and NICU admission and eosinophilic oesophagitis (adjusted OR 2.4; 95% CI 1.1‒5.5). Moreover, a stronger association was observed between NICU admission and eosinophilic oesophagitis in term (adjusted OR 1.9; 95% CI 1.3‒2.8) than in preterm infants (adjusted OR 0.6; 95% CI 0.3‒1.3).

Therefore, the authors concluded that the association between NICU admission and eosinophilic oesophagitis is independent of the preterm status. Furthermore, pregnancy complications also elevated the risk of eosinophilic oesophagitis (adjusted OR 1.4; 95% CI 1.0‒1.8) whereas weight for gestational age and caesarean delivery didn’t have an influence.

When the gestational age at the delivery was considered, the risk of developing eosinophilic oesophagitis was highest when delivered at the 33rd week of gestation. Regarding the association with the NICU admission, the risk of developing eosinophilic oesophagitis was highest at 2‒3 weeks of NICU admission.

The authors of the study suggest that there is a need for further research to elucidate the underlying pathway of the above associations.

1. Kurt G, et al. Perinatal factors and risk of eosinophilic esophagitis - a Nationwide population based case-control study. Poster Su1181, Digestive Disease Week 2022, 21‒24 May, San Diego, CA, USA.

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Posted on 14 June 2022