title: Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. edellon@med.unc.edu
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.forename: Anne F
authors.initials: AF
authors.lastname: Peery
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Morgan
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hurrell
authors.forename: Richard H
authors.initials: RH
authors.lastname: Lash
authors.forename: Robert M
authors.initials: RM
authors.lastname: Genta
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003430:Cross-Sectional Studies; D057765:Eosinophilic Esophagitis / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D004947:Esophagus / Q000382:microbiology / Q000473:pathology; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013270:Stomach / Q000382:microbiology / Q000473:pathology; D014481:United States / Q000453:epidemiology