Over the last three decades, researchers and doctors have noticed a concerning trend: increasing cases of eosinophilic esophagitis (EoE), a chronic digestive system disorder, in infants and children. In particular, more children in Europe, South America, and the U.S. are being diagnosed with this condition.
But why is that? This is the question that researchers hoped to answer in a study evaluating data from families in Denmark. In our early life, as we’re developing, we might be susceptible to different environmental or developmental triggers. These can disrupt our gut microbiome, which research has shown plays a role in on other health outcomes and even our immune health. This means that, if our gut microbiome or immune system is altered in infancy, it can have life-long health impact. According to Rose Weldon in Healio, researchers focused in on the use of acid suppressants and antibiotics in mothers and infants as a potential cause of EoE.
Impacts of Antibiotic Use
The study, published in JAMA Pediatrics, focused on data from 392 children with eosinophilic esophagitis over a 23-year period, as well as 3,637 matched controls. Males comprised a majority of cases. Data also included information on maternal antibiotic or acid suppressant use. Findings from the study suggest that:
- Children who were given any antibiotics in infancy had a 40% risk of developing eosinophilic esophagitis compared to children who did not require antibiotics.
- If children were given three or more antibioitcs in infancy, the risk of EoE increased by 80%.
- The strongest association between antibiotic use and EoE risk occurred in early infancy, or between birth and six months.
- If mothers used antibiotics, their child had an increased risk of developing EoE – especially if antibiotic use occurred between the third trimester and first six months following birth. The researchers also noted that mothers who were given three or more prescriptions had the highest risk of their child having EoE.
- The risk of EoE increased with acid suppressant use.
Researchers suggest that, moving forward, additional research should explore whether the risk changes based on socioeconomic status or other social factors; this research might also explore the barriers to care that families face, as well as the over- or under-prescribing of antibiotics.
What to Know about EoE
As described briefly above, eosinophilic esophagitis is a chronic, immune-mediated disorder. Normally, our eosinophils (a type of white blood cell) help our body fight infection. A high accumulation of eosinophils also suggests an allergic disease. In eosinophilic esophagitis, eosinophils collect in the esophagus, a tube that carries food from your mouth to your stomach. Doctors surmise that EoE results from immune hypersensitivity to certain foods or environmental allergens. There is also a proposed genetic component, with some people showing high eotaxin-3 gene expression. EoE is treated with diet changes, proton pump inhibitors, and dupilumab (Dupixent), the first FDA-approved treatment for this condition.
Symptoms present in eosinophilic esophagitis can include:
- A higher risk of having other allergic conditions like asthma or allergies
- Dysphagia (difficulty swallowing)
- Stomach pain
- Poor or stunted growth
- Chest pain
- Heartburn
- Unintentional weight loss
- Appetite loss
- Food impaction (food getting stuck in the throat)
- Nausea and vomiting
- Malnutrition