P1835 - Helicobacter pylori Is Associated With a Significantly Reduced Risk of Eosinophilic Esophagitis: A Cohort Study Using the National Veterans Health Administration Data

Eric E. Low, MD, MPH¹, Joshua Demb, PhD, MPH², Rena Yadlapati, MD, MS¹, Samir Gupta, MD, MSCS², Evan S.. Dellon, MD, MPH³, Seema S. Aceves, MD, PhD⁴, Lin Liu, PhD², Yash A. Choksi, MD⁵, Shailja C. Shah, MD, MPH^2
1University of California San Diego, San Diego, CA; ²Jennifer Moreno Veteran Affairs San Diego Healthcare System, San Diego, CA; ³Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC; ⁴University of California, San Diego Rady Children’s Hospital, San Diego, CA; ⁵Veterans Affairs Tennessee Valley Health Care System, Nashville, TN

Introduction: Eosinophilic esophagitis (EoE) is a chronic allergen/immune-mediated condition of the esophagus. Infection with Helicobacter pylori may promote immunotolerance and protect against immune-mediated conditions. We aimed to test the hypothesis that H. pylori exposure is inversely associated with EoE risk using a national cohort of 936,399 H. pylori tested individuals.

Methods: We assembled a retrospective and previously validated cohort of Veterans who completed H. pylori testing with non-serologic (including histology) or serologic tests between 1999-2018. Veterans without H. pylori testing were excluded to avoid exposure misclassification. We performed multivariable logistic regression analyses to evaluate the association between H. pylori exposure and EoE, and H. pylori treatment and EoE, adjusted for age, sex, race, ethnicity, smoking status, body mass index, and geography, expressed as adjusted odds ratios (aORs) and relative risk (aRR) along with 95% confidence intervals (CIs), respectively. Exploratory analyses were performed to examine the association of H. pylori infection and presence of other immune-mediated diseases.

Results: Among 936,399 Veterans with completed H. pylori testing, 218,763 (23.4%) tested positive. Subsequent EoE diagnosis was observed among 0.13% (288/218,763) of H. pylori positive individuals versus 0.35% (2,573/717,636) of H. pylori negative individuals. Veterans who were H. pylori positive had 47% lower odds of EoE, compared to those who were H. pylori negative (aOR 0.53; 95%CI 0.47-0.61) (Table). H. pylori treatment was not significantly associated with developing EoE among Veterans with H. pylori positivity (aRR 1.18; 95%CI 0.75-1.84; reference: no H. pylori treatment). Diagnosis of a broad range of atopic and immune-mediated conditions was less common among H. pylori positive vs H. pylori negative individuals: aOR 0.91 (95%CI 0.90-0.93) for asthma; aOR 0.87 (95%CI 0.85-0.88) for atopic dermatitis; aOR 0.96 (95%CI 0.93-0.99) for food allergies; aOR 0.70 (95%CI 0.66-0.75) for Crohn’s disease; and aOR 0.82 (95%CI 0.78-0.87) for ulcerative colitis (Figure).

Discussion: H. pylori positivity was associated with lower odds of EoE diagnosis in a national cohort, and treatment for H. pylori did not modify EoE risk. In addition to EoE, H. pylori positivity was associated with lower odds of developing other atopic and immune-mediated diseases. Further prospective studies are needed to examine a causal relationship.



Disclosures:


Eric E. Low, MD, MPH¹, Joshua Demb, PhD, MPH², Rena Yadlapati, MD, MS¹, Samir Gupta, MD, MSCS², Evan S.. Dellon, MD, MPH³, Seema S. Aceves, MD, PhD⁴, Lin Liu, PhD², Yash A. Choksi, MD⁵, Shailja C. Shah, MD, MPH². P1835 - Helicobacter pylori Is Associated With a Significantly Reduced Risk of Eosinophilic Esophagitis: A Cohort Study Using the National Veterans Health Administration Data, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.