title: Early life exposures as risk factors for pediatric eosinophilic esophagitis.
abstract: OBJECTIVE
  Few etiologic studies of eosinophilic esophagitis (EoE) have been conducted. Early life exposures have been shown to predispose to other allergic disease, but their role has not been assessed in EoE. The present study sought to explore early life exposures as possible risk factors for developing EoE in the pediatric population.
  
  
  METHODS
  This was a 2-phase case-control study conducted at the University of North Carolina. The first phase consisted of survey development for early life exposures via cognitive interview. In the second phase, a telephone-based questionnaire was administered to cases with EoE (n = 31) and 2 sets of controls, patients with gastroesophageal reflux disease, and siblings of nonsyndromic cleft lip/palate patients (n = 26 in each). Different controls were explored to identify controls reflective of the source population of the cases. Siblings of cleft lip/palate patients were identified as the more suitable control population. Odds ratios were calculated to evaluate the association between early life exposures and the development of pediatric EoE.
  
  
  RESULTS
  Early life exposures were associated with increased odds of developing pediatric-onset EoE. Antibiotic use in infancy was associated with 6 times the odds of having EoE (95% confidence interval 1.7-20.8). Cesarean delivery, preterm birth, and formula-only or mixed (infant formula and breast milk) feeding also have trends toward increased odds for developing EoE.
  
  
  CONCLUSIONS
  A number of early life exposures may be associated with the development of EoE. These are potentially modifiable risk factors that if confirmed would have implications for improved understanding of EoE pathogenesis and disease prevention.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA. ecjensen@email.unc.edu
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Jensen
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
authors.forename: Hannah P
authors.initials: HP
authors.lastname: Kim
authors.forename: Tamar
authors.initials: T
authors.lastname: Ringel-Kulka
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects; D002648:Child; D002657:Child Development / Q000187:drug effects; D002675:Child, Preschool; D035061:Control Groups; D057765:Eosinophilic Esophagitis / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D005240:Feasibility Studies; D005247:Feeding Behavior; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010865:Pilot Projects; D011247:Pregnancy; D047928:Premature Birth / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents