Speculation as to why the Frequency of Eosinophilic Esophagitis Is Increasing

Current Gastroenterology Reports
Stuart Jon Spechler

Abstract

The frequency of eosinophilic esophagitis (EoE), an immune/antigen-mediated disorder first described in 1993, has been increasing rapidly. The purpose of this review is to consider hypotheses proposed to explain this increase and to speculate on their validity. The hygiene hypothesis attributes the rise of EoE to modern hygienic conditions resulting in fewer childhood infections with microbes that might have protected against allergy development. Microbial dysbiosis, a change in the microbiome's composition and diversity caused by a modern affluent lifestyle, also might contribute to allergic conditions. Environmental factors including modern chemicals contaminating crops, livestock treated with hormones and antibiotics, food additives and processing changes, and pollutants in the air and water conceivably might predispose to EoE. One intriguing hypothesis attributes increasing EoE to increasing use of acid-suppressive medications like proton pump inhibitors, which might prevent peptic digestion of food allergens, increase gastric permeability, and alter the microbiome to favor food allergy development. In a recent pediatric case-control study, use of acid suppressants in infancy was by far the single strongest risk factor iden...Continue Reading

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Citations

Jul 26, 2019·Journal of Gastroenterology·Stuart Jon Spechler
Dec 14, 2019·BMJ Case Reports·Lybil Briscia Mendoza AlvarezSarah Glover
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Feb 23, 2019·Expert Review of Gastroenterology & Hepatology·Ángel Arias, Alfredo J Lucendo
Oct 27, 2018·Frontiers in Medicine·Elisa Gomez TorrijosJoan Bartra
Jun 18, 2020·Frontiers in Pediatrics·Martina VottoAmelia Licari
Jun 8, 2021·Seminars in Immunopathology·Luc BiedermannPhilipp Schreiner

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