Psychiatric Disease Risk Higher for Patients With EoE, Study Says

A study published earlier this year suggests that patients with eosinophilic esophagitis (EoE) may have a greater risk of psychiatric disease.

Other gastrointestinal disorders and inflammatory diseases have also been linked to psychiatric disorders, but not much is known about the connection to EoE. Prior research has been limited or linked to single-center studies.

The current study was population based and nationwide and conducted in Sweden, which has robust patient data due to its national health care system.

Through a diagnostic code search, researchers identified patients with EoE diagnosed from 1989 to 2017 without a prior psychiatric diagnosis (n = 1458) identified through the ESPRESSO histopathology cohort, which represents all gastrointestinal biopsy reports in Sweden’s 28 pathology departments. That data was linked with the Total Population Register and the National Patient Register (NPR).

Those with EoE were matched with up to 5 controls by sex, age, county, and calendar year (n = 6436).

The risk of psychiatric disease was determined by codes for antidepressants, antipsychotics, attention-deficit/hyperactivity disorder (ADHD) medications, hypnotics and sedatives, and anxiolytics. Outcomes included any psychiatric disorder and suicide attempt.

Cox proportional hazard modeling estimated adjusted hazard ratios (aHRs). In a secondary analysis, the study also examined sibling data to look for the possibility of confounders, comparing 1055 patients with EoE with their siblings (n = 1669) in order to examine and adjust for genetic and early environmental factors.

The median age at EoE diagnosis was 39 years, and most (76%) were male. The median follow-up time was 4 years. In patients with EoE, dysphagia was present in 70% and food impaction in 58%.

EoE was linked to mood disorders, anxiety disorder, and ADHD. Specifically, results showed:

• 106 patients with EoE (15.96/1000 person-years) developed a psychiatric disorder, compared with 331 (10.93/1000 person-years) controls (HR, 1.50; 95% CI, 1.20-1.87).
• Increased risk was seen in the first 5 years of follow-up, but not afterwards
• Being diagnosed with EoE in childhood led to the highest relative risks of having a psychiatric disorder later
• Those with EoE had an increased risk of psychiatric disease compared with their siblings (HR, 1.62; 95% CI, 1.14-2.31).

The researchers said their work adds to earlier knowledge because of more precise estimates of both hazard ratios and absolute risks, the longer follow-up period, adjustment for confounders, sibling comparisons, and the discovery that a higher risk for a psychiatric disroder exists when EoE starts in childhood.

The higher rate of psychiatric disorders in the 5 years following an EoE diagnosis may stem from the more intense health care during this time, the authors said.

Among the study's weaknesses, the researchers noticed that there was a lack of data on smoking and disease intensity.

The results were not affected by controlling for other gastrointestinal diseases or asthma, suggesting that EoE itself is responsible for the increase in psychiatric problems. While chronic illnesses typically carry concerns that could impact social functioning, the unique factors of EoE, namely dysphagia, fear of food impaction, and limited or heavily restricted diets, can lead to further social isolation and distress, the researchers said.

“Our findings underscore the importance of a multidisciplinary team approach to caring for patients with EoE, particularly focusing on integration of medical and psychological support for these patients," they wrote. "Annual follow-up with quality of life survey or depression/anxiety screening should be considered in EoE patients.”

Reference

Röjler L, Garber JJ, Butwicka A, Roelstraete B, Ludvigsson JF. Individuals with eosinophilic esophagitis are at greater risk of later psychiatric disorder. Am J Gastroenterol. Published online March 28, 2022. doi:10.14309/ajg.0000000000001749