Helicobacter Pylori Infection Does Not Protect Against Eosinophilic Esophagitis: Results From a Large Multicenter Case-Control Study
Por:
Molina-Infante, J, Gutierrez-Junquera, C, Savarino, E, Penagini, R, Modolell, I, Bartolo, O, Prieto-Garcia, A, Mauro, A, Alcedo, J, Perello, A, Guarner-Argente, C, Alcaide, N, Vegas, AM, Barros-Garcia, P, Murzi-Pulgar, M, Perona, M, Gisbert, JP, Lucendo, AJ, Upper GI Tract Study Grp Spanish
Publicada:
1 jul 2018
Resumen:
OBJECTIVES: Rising trends in eosinophilic esophagitis (EoE) have been repeatedly linked to declining Helicobacter pylori (H. pylori) infection, mostly in retrospective studies. We aimed to prospectively evaluate this inverse association.
METHODS: Prospective case-control study conducted in 23 centers. Children and adults naive to eradication therapy for H. pylori were included. Cases were EoE patients, whereas controls were defined by esophageal symptoms and <5 eos/HPF on esophageal biopsies. H. pylori status was diagnosed by non-invasive (excluding serology) or invasive testing off proton pump inhibitor (PPI) therapy for 2 weeks. Atopy was defined by the presence of IgE-mediated conditions diagnosed by an allergist.
RESULTS: 808 individuals, including 404 cases and 404 controls (170 children) were enrolled. Overall H. pylori prevalence was 38% (45% children vs. 37% adults, p 0.009) and was not different between cases and controls (37% vs. 40%, p 0.3; odds ratio (OR) 0.97; 95% confidence interval (CI) 0.73-1.30), neither in children (42% vs. 46%, p 0.1) nor in adults (36% vs. 38%, p 0.4). Atopy (OR 0.85; 95% CI 0.75-0.98) and allergic rhinitis (OR 0.81; 95% CI 0.68-0.98) showed a borderline inverse association with H. pylori infection in EoE patients. This trend was not confirmed for asthma or food allergy.
CONCLUSIONS: H. pylori infection was not inversely associated with EoE, neither in children nor in adults. A borderline inverse association was confirmed for atopy and allergic rhinitis, but not asthma of food allergy. Our findings question a true protective role of H. pylori infection against allergic disorders, including EoE.
Filiaciones:
Molina-Infante, J:
Hosp Univ San Pedro Alcantara, Dept Gastroenterol, Caceres, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Gutierrez-Junquera, C:
Hosp Univ Puerta Hierro Majadahonda, Dept Pediat, Pediat Gastroenterol Unit, Madrid, Spain
Savarino, E:
Univ Padua, Div Gastroenterol Oncol & Gastroenterol, Dept Surg, Padua, Italy
Penagini, R:
Univ Milan, Gastroenterol & Endoscopy Unit, Milan, Italy
Modolell, I:
Consorci Sanitari Terrassa, Dept Gastroenterol, Barcelona, Spain
Bartolo, O:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Prieto-Garcia, A:
Hosp Univ Gregorio Maranon, Dept Allergy, Madrid, Spain
Mauro, A:
Univ Milan, Gastroenterol & Endoscopy Unit, Milan, Italy
Alcedo, J:
Hosp Univ Miguel Servet, Dept Gastroenterol, Zaragoza, Spain
Perello, A:
Hosp Viladecans, Dept Gastroenterol, Barcelona, Spain
Guarner-Argente, C:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Barcelona, Spain
Alcaide, N:
Hosp Clin Univ, Dept Gastroenterol, Valladolid, Spain
Vegas, AM:
Hosp Univ Rio Hortega, Clin Anal & Pediat, Valladolid, Spain
Barros-Garcia, P:
Hosp Univ San Pedro Alcantara, Dept Pediat, Caceres, Spain
Murzi-Pulgar, M:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Barcelona, Spain
Perona, M:
Hosp Quiron, Dept Gastroenterol, Marbella, Spain
Gisbert, JP:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa IIS IP, Dept Gastroenterol, Madrid, Spain
CIBEREHD, Madrid, Spain
Lucendo, AJ:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Gen Tomelloso, Dept Gastroenterol, Tomelloso, Spain
CIBEREHD, Ciudad Real, Spain
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