EoE Studies Examine Early Life Influences, Alignment of Parent-Child Reports

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that affects the gastrointestinal tract with increasing incidence and prevalence. Abstracts presented at a recent meeting of allergists and immunologists explored early factors in disease development of EoE as well as symptoms reported by parents and children.

At the American Academy of Allergy Asthma and Immunology annual meeting, an abstract described some possible associations with risk factors that develop in the perinatal period.¹

So far, what is known about these early life exposures comes from retrospective data through tertiary centers, and the authors of the current research noted that means the data are subject to information bias. Current theories point to alterations in the colonization of the gut microbiome and subsequent dysregulated immune system development. Known risk factors include male sex, Caucasian race, and atopic comorbidities, including food allergy, asthma, and atopic dermatitis. The timing and type of food introduction are also suspected.

In this work, researchers conducted a nationwide, registry-based case-control study of perinatal exposures, using data collected prospectively through Danish health and administrative registries.

Identifying all pediatric EoE cases in Denmark during birth years 1997 to 2018, the investigators obtained the following information:

• Data on pregnancy complications
• Mode of delivery
• Gestational age at delivery
• Birth weight
• Neonatal intensive care unit (NICU) admission
  

Cases were sex and age matched 1:10 with controls, with risk set sampling of controls, and the researchers estimated the odds of EoE, relative to each perinatal factor and adjusting for possible confounders, using conditional logistic regression models.

Overall, there were 393 cases and 3659 controls after exclusions for missing data (n = 23 cases and n = 501 controls).

The strongest evidence of an association was seen with gestational age and EoE peaking at 34 vs 40 weeks (adjusted odds ratio [aOR], 2.5; 95% CI, 1.5-4.0), and NICU admission and EoE peaking at 2 to 3 weeks NICU stay vs no admission (aOR, 2.4; 95% CI, 1.1-5.5).

The investigators also saw a trend between pregnancy complications and EoE (aOR, 1.4; 95% CI, 1.0-1.8).

Researchers did not find evidence of a link for weight for gestational age or cesarean delivery.

“Perinatal factors, particularly preterm delivery and NICU admission, are associated with the development of EoE,” the authors concluded.

In the other abstract, investigators sought to understand the relationship between parent- and self-reported symptoms and quality of life in a multicenter prospective EoE cohort enrolled in the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR).

During a nearly 5-year period, 292 patients with EoE patients and their parents completed 723 questionnaires. Correlation and agreement were assessed between parent- and self-reported symptoms using the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS v2.0) and the EoE-Quality of Life (EoE-QL) survey, with results analyzed with Pearson correlation coefficients and illustrated by Bland-Altman plot. Factors influencing symptoms or quality of life were assessed using linear mixed models.

The PEESS asks about dysphagia, nausea/vomiting, gastrointestinal reflux disease, and pain.

The majority of the group were male and White. By age, 28% were older than 13 years, 38% were aged 8 to 12 years, 23% were aged 5 to 7 years , and 10% were aged 2 to 4 years.

Overall, 86 (64%) subjects were surveyed at least 2 times with a between-survey time of 1 year. Over time, PEESS v2.0 scores improved in 44% of parents and 46% of children, and they were static in 12% of parents and 14% of children.

Parent and child scores were highly correlated (r = 0.83) and correlations were similar between younger and older children (8-12 vs ≥13 years; P = .76).

Self-reported total symptom score was linked with sex (P = .019) and race (P = .002), as female and Black children reported worse symptoms.

Parent and child EoE-QL correlated across the ages (r = 0.74), most strongly in children aged 5 to 7 years (r = 0.84). Sex and age influenced the parent and self-reported total EoE-QL and its subdomains.

"There are moderate to strong correlations between child and parent reported PEESS v2.0 and EoE-QL over time," the researchers wrote.

The finding that female and Black children reported worse symptoms deserves additional study, they concluded.

References

1. Svane H, Heide-Jørgensen U, Sørensen H, Dellon E, Jensen E. Perinatal factors increase risk of eosinophilic esophagitis–a nationwide case-control study. Presented at: 2022 Annual Meeting of the American Academy of Allergy, Asthma & Immunology; February 25-28, 2022; Phoenix, Arizona. Abstract 205.

2. Martin L, Znang X, Chehade M, et al. Longitudinal association of parent and child patient reported outcomes in eosinophilic esophagitis in a multicenter cohort. Presented at: 2022 Annual Meeting of the American Academy of Allergy, Asthma & Immunology; February 25-28, 2022; Phoenix, Arizona. Abstract 618.