Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
Gastroenterology. 2011 Nov;141(5):1586-92. doi: 10.1053/j.gastro.2011.06.081. Epub 2011 Jul 14.
BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is of increasing prevalence and believed to result from allergic processes. Helicobacter pylori has been inversely associated with allergic diseases, but there is no known relationship between H pylori, EoE, and esophageal eosinophilia. We investigated the association between esophageal eosinophilia and H pylori infection.
We performed a cross-sectional study of data, collected from a US pathology database, on 165,017 patients in the United States who underwent esophageal and gastric biopsies from 2008 through 2010. Patients with and without H pylori on gastric biopsy were compared, and odds of esophageal eosinophilia were determined.
From the data analyzed, 56,301 (34.1%) had normal esophageal biopsy specimens, 5767 (3.5%) had esophageal eosinophilia, and 11,170 (6.8%) had H pylori infection. Esophageal eosinophilia was inversely associated with H pylori (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.69-0.87). Compared with patients with normal esophageal biopsy specimens, odds of H pylori were reduced among patients with ≥ 15 eosinophils per high-power field (eos/hpf) (OR, 0.79; 95% CI, 0.70-0.88), ≥ 45 eos/hpf (OR, 0.75; 95% CI, 0.61-0.93), ≥ 75 eos/hpf (OR, 0.72; 95% CI, 0.50-1.03), and ≥ 90 eos/hpf (OR, 0.52; 95% CI, 0.31-0.87) (P for trend <.001). A similar dose-response trend was observed for increasing clinical suspicion for EoE and decreasing prevalence of H pylori. Additionally, severity of histologic effects of H pylori was inversely associated with esophageal eosinophilia. All trends held in multivariate analysis.
In a large cross-sectional analysis, H pylori infection was inversely associated with esophageal eosinophilia. This relationship could have implications for the pathogenesis and epidemiology of EoE.
嗜酸性食管炎（EoE）的发病率不断上升，据信是过敏过程的结果。幽门螺杆菌与过敏疾病呈负相关，但目前尚不清楚幽门螺杆菌、EoE 和食管嗜酸性粒细胞之间的关系。我们研究了食管嗜酸性粒细胞与幽门螺杆菌感染之间的关联。
我们对美国一家病理学数据库在 2008 年至 2010 年间收集的 165017 名接受食管和胃活检的患者的数据进行了横断面研究。比较了胃活检有和无幽门螺杆菌的患者，并确定了食管嗜酸性粒细胞增多的可能性。
在所分析的数据中，56301 例（34.1%）食管活检标本正常，5767 例（3.5%）食管嗜酸性粒细胞增多，11170 例（6.8%）幽门螺杆菌感染。食管嗜酸性粒细胞增多与幽门螺杆菌呈负相关（比值比[OR]，0.77；95%置信区间[CI]，0.69-0.87）。与食管活检标本正常的患者相比，≥15 个嗜酸性粒细胞/高倍视野（eos/hpf）（OR，0.79；95%CI，0.70-0.88）、≥45 eos/hpf（OR，0.75；95%CI，0.61-0.93）、≥75 eos/hpf（OR，0.72；95%CI，0.50-1.03）和≥90 eos/hpf（OR，0.52；95%CI，0.31-0.87）的患者幽门螺杆菌感染的可能性降低（趋势 P<0.001）。随着对 EoE 临床怀疑程度的增加和幽门螺杆菌流行率的降低，观察到类似的剂量反应趋势。此外，幽门螺杆菌组织学效应的严重程度与食管嗜酸性粒细胞增多呈负相关。所有趋势在多变量分析中均成立。
在一项大型横断面分析中，幽门螺杆菌感染与食管嗜酸性粒细胞增多呈负相关。这种关系可能对 EoE 的发病机制和流行病学有影响。
