S476 Early Childhood Environmental Risks for Eosinophilic Esophagitis: A Systemic Review and Meta-analysis

Introduction: Eosinophilic esophagitis (EoE) is a relatively new disease with an incomplete understanding of the potential environmental risk factors. The aim of this study is to determine a potential association between perinatal risk factors and EoE. Methods: A search was conducted for relevant studies published up to June 2022 using MEDLINE, EMBASE, Scopus Web of Sciences, and Cochrane databases. Risk ratio (RR) with 95% confidence interval (CI) were estimated using a random-effects model. Results: Eight case-control studies were included in the analysis, with a total 2,128 cases of patients with EoE and 6,943 controls. There were 7 studies (2,109 EoE and 6,886 controls) included for risk of infant antibiotic use, with 5 of 7 studies demonstrating a significant positive association with a pooled risk ratio of 1.32 (95%CI: 1.05-1.66, P=0.02, I2 = 88%) (Figure 1, Panel 1). There were 5 studies (687 EoE and 3933 controls) included for cesarean section with pooled risk ratio of 1.25 (95%CI: 1.05-1.40, P=0.009, I2 = 0%) (Figure 1, Panel 2). There were 4 studies (283 EoE and 402 controls) for breastfeeding with pooled risk ratio of 1.04 (95%CI: 0.96-1.11). There were 5 studies (1,986 EoE and 6,716 controls) for preterm birth with pooled risk ratio of 1.32 (95%CI: 0.86-2.04, P=0.21, I2 = 75%). Conclusion: This meta-analysis suggests that antibiotic use during the first year of life and cesarean section are associated with EoE. Further studies are warranted to confirm these findings as they may be indirect associations rather than causal.Figure 1.: (Panel 1) Forest plot of 7 studies showing risk ratio of the association between neonatal antibiotic use and EoE. (Panel 2) Forest plot of 7 studies showing risk ratio of the association between cesarean section and EoE.