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Review
. 2024 Aug 6;16(8):e66326.
doi: 10.7759/cureus.66326. eCollection 2024 Aug.

Perinatal Environmental Risks for Eosinophilic Esophagitis: A Systemic Review and Meta-Analysis

Nicha Wongjarupong  1 , Malique Delbrune  2 , Busara Songtanin  3 , Erin E Reardon  4 , Daphne M Moutsoglou  5   6 , Vikram J Christian  7 , Joshua A Sloan  1
Affiliations
Review

Perinatal Environmental Risks for Eosinophilic Esophagitis: A Systemic Review and Meta-Analysis

Nicha Wongjarupong et al. Cureus. .

Abstract

There are limited data on the association of eosinophilic esophagitis (EoE) and environmental risk factors. The aim of this study was to determine the potential associations between perinatal risk factors and EoE. A search was conducted for relevant studies published up to December 12th, 2023, using MEDLINE, EMBASE, Scopus, Web of Sciences, and Cochrane databases. Risk ratios with the 95% confidence interval (CI) were estimated using a random-effects model. Case-control or cohort studies that determined perinatal environmental factors within the first year of life and their association with EoE were included. Six case-control studies were included in the analysis. Six studies (2,087 EoE and 6,786 controls) were included for risk of infant antibiotic use with a pooled risk ratio of 1.30 (95%CI: 1.11-1.52, I2 = 76%), and five studies were included for cesarean section with a pooled risk ratio of 1.22 (95%CI: 1.10-1.34, I2 = 5%). There were three studies for breastfeeding with a pooled risk ratio of 1.07 (95%CI: 1.00-1.15, I2 = 0%); five studies were included for preterm birth with a pooled risk ratio of 1.52 (95%CI: 1.14-2.04, I2 = 48%). There were three studies for neonatal intensive care unit admission with a pooled risk ratio of 1.75 (95% CI: 1.41-2.18, I2 = 0%). Publication bias was found between EoE and infant antibiotic use and cesarean section, but not for EoE and preterm birth, neonatal care unit admission, or breastfeeding. This meta-analysis suggests a weak association between antibiotic use during the first year of life, cesarean section, preterm birth, and neonatal intensive care unit admission and a possible risk of EoE. Further studies are warranted to confirm these findings as they may be indirect associations rather than causal.

Keywords: antibiotic; cesarean section; eosinophilic esophagitis; preterm; risk factor.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Joshua A Sloan declare(s) personal fees from Sanofi-Regeneron. Speakers bureau and advisory board . Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers, and other sources
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses; EoE: eosinophilic esophagitis
Figure 2
Figure 2. Forest plot of studies showing the risk ratio of the association between infant antibiotic use and EoE
EoE: eosinophilic esophagitis
Figure 3
Figure 3. Forest plot of studies showing the risk ratio of the association between cesarean section and EoE
EoE: eosinophilic esophagitis
Figure 4
Figure 4. Forest plot of studies showing the risk ratio of the association between preterm birth and EoE
EoE: eosinophilic esophagitis
Figure 5
Figure 5. Forest plot of studies showing the risk ratio of the association between neonatal intensive care unit admission and EoE
EoE: eosinophilic esophagitis
Figure 6
Figure 6. Forest plot of studies showing the risk ratio of the association between breastfeeding and EoE
EoE: eosinophilic esophagitis
Figure 7
Figure 7. Funnel plot of publication bias for association between infant antibiotic use and EoE
EoE: eosinophilic esophagitis
Figure 8
Figure 8. Funnel plot of publication bias for association between cesarean section and EoE
EoE: eosinophilic esophagitis
Figure 9
Figure 9. Funnel plot of publication bias for the association between preterm delivery use and EoE
EoE: eosinophilic esophagitis
See this image and copyright information in PMC

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