January 17, 2019
1 min read

H. pylori exposure protects against eosinophilic esophagitis

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Exposure to Helicobacter pylori could be protective against the development of eosinophilic esophagitis, according to a meta-analysis published in Clinical Gastroenterology and Hepatology.

Shailja C. Shah, MD, of Vanderbilt University Medical Center, and colleagues wrote that some epidemiologic data show that current or previous H. pylori exposure protects against immune-mediated conditions such as inflammatory bowel disease and food allergies.

H. pylori infection often occurs in early childhood, and this early immunoregulation and enhanced immunotolerance may plausibly protect against the later development of aberrant Th2-mediated immune responses driving immune-mediated diseases in a susceptible host,” they wrote. “Unfortunately, direct experimental evidence clarifying the role, if any, of H. pylori on the development of EoE is lacking.”

Investigators searched the literature for comparative clinical studies that included enough information to determine the odds or risk of EoE or esophageal eosinophilia among patients exposed to H. pylori compared with individuals who were not.

Researchers identified 11 observational studies comprising 377,795 individuals. They found that H. pylori exposure was associated with a 37% reduction in odds of EoE (OR = 0.63; 95% CI, 0.51-0.78) and a 38% reduction in odds of esophageal eosinophilia (OR = 0.62; 95% CI, 0.52-0.76).

The odds remained steady across studies regardless of location or time period, and among pediatric and adult populations. However, fewer prospective studies found a significant association compared with retrospective studies.

Shah and colleagues wrote that the analysis was limited because of their use of observational studies, and future prospective trials are needed.

“Studies in experimental models of EoE would further clarify the putative role of H. pylori in EoE pathophysiology by defining mechanisms active in the early phase of disease and protective pathways that, in the future, might be leveraged for clinical benefit,” they wrote. – by Alex Young

Disclosures: The authors report no relevant financial disclosures.