Environmental factors and eosinophilic esophagitis

Publication date: Available online 2 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Elizabeth T. Jensen, Evan S. Dellon
The incidence and prevalence of eosinophilic esophagitis (EoE) have markedly increased over the past two decades, outpacing increased detection of the disease. While genetic susceptibility markers for EoE have begun to be elucidated, the rate at which EoE has increased in incidence suggests environmental factors predominate. Despite many advances in the understanding of the pathogenesis of EoE, the etiology of EoE is unknown. This paper reviews the emerging data related to environmental risk factors for EoE. Many of these environmental factors are rooted in the theoretical framework of the hygiene hypothesis, specifically mediation of disease development through dysbiosis. Other hypotheses are based on associations that have been observed in studies of non-EoE allergic disease. We describe the evidence that early life exposures, including antibiotic use, acid suppression, and cesarean delivery may increase risk of disease. We also describe the evidence that infectious agents, such as Helicobacter pylori, are inversely associated with disease. Current evidence on geographic risk factors, such as population density, climate zone, and seasonality is reviewed. We also describe behavioral factors that have been evaluated. Limitations of the existing research are discussed and recommendations for future areas of research, including assessment of gene-environment interaction, are presented.



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