283. DOES PROTON PUMP INHIBITOR EXPOSURE INCREASE THE RISK OF DEVELOPING EOSINOPHILIC ESOPHAGITIS IN CHILDREN WITH ESOPHAGEAL ATRESIA?

Abstract

Abstract Children with esophageal atresia (EA) receive proton pump inhibitors (PPIs) long-term due to gastroesophageal reflux disease susceptibility. They have also demonstrated greater susceptibility to eosinophilic esophagitis (EoE) compared to the general pediatric population. No studies have investigated EoE risk factors in EA. This study aimed to determine whether PPI exposure and early-life factors are associated with an increased risk for subsequent EoE development in children with EA. A retrospective chart review was undertaken at a paediatric hospital in Sydney, Australia. The study cohort consisted of children with EA who had their repair and/or follow-up at this hospital between 1 January 2005 and 31 December 2020. Children with EA and EoE (cases) were matched (1:2) with those with only EA (controls), for sex, prematurity and presence of long-gap, to compare PPI exposure. Other early-life factors were analysed without matching, using simple and multivariable logistic regression. Of the 184 children with EA, 46 (25%) developed EoE during this period. Thirty-eight EoE participants were matched to 76 controls. Children with EA and EoE received PPI for significantly higher durations (p = 0.018) and at significantly higher cumulative doses (p = 0.017) than children with EA but no EoE. Food allergy (adjusted odds ratio [aOR], 10.515; 95% confidence interval [CI], 2.659–41.581), family history of atopy (aOR, 5.312; 95% CI, 1.575–17.911) and infantile antibiotic exposure (aOR, 1.048; 95% CI, 1.011–1.086) were also significantly associated with an increased risk of developing EoE in the EA cohort. Longer durations of PPI exposure and exposure to higher cumulative doses of PPI were both associated with the subsequent development of EoE in children with EA. Other early life factors such as atopic family history, food allergy and infantile antibiotic exposure were also significantly associated with an increased risk of developing EoE in children with EA.