AUTOIMMUNE DISEASE BURDEN IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS: A NATIONWIDE LONGITUDINAL STUDY.

Abstract

<h3>Introduction</h3> Eosinophilic Esophagitis (EoE) is a chronic immune mediated disorder involving eosinophils leading to esophageal dysfunction. In this retrospective multi-center study, we investigated the incidence and risk factors for comorbid autoimmune diseases (AiD) in children using Cerner Health Facts, a national longitudinal database representing approximately 69 million patients. <h3>Methods</h3> All patients under 18 years of age with EoE were included in our analysis. Patient characteristics were evaluated as potential risk factors for comorbid AiD using multivariable regression built using all variables with p<0.05 on univariable analysis. <h3>Results</h3> We identified 6,285 patients with EoE. Mean age was 9.41±5.04 years, 32.04% (2,014) were female. In terms of race, 75.27% (4,731) were white and 11.81% (742) were African American. Overall, 7.0% (440/6,285) of children with EoE had at least one comorbid AiD. The most common AiD in those with EoE was ulcerative-colitis (143) followed by celiac (116) and autoimmune-thyroid disease (89). On multivariable regression, the factors associated with a higher risk of AiD included type-2 diabetes (odds-ratio (OR) 4.46), steroid use (OR 3.51), long-term medication use (OR 2.42), and digestive disorders (OR 1.85). African American race decreased the risk of AiD (OR 0.64). <h3>Conclusion</h3> We utilized a national database of patients with diag nosed EoE to identify the incidence and risk factors for AiD. Ulcerative colitis, celiac, and autoimmune thyroid disease were the most common AiD comorbid with EoE. The greatest risk factor for AiD was type-2 diabetes. Given that nearly 7% of identified EoE patients had comorbid AiD, careful evaluation for AiD in EoE setting may be warranted. We compared patient characteristics and variables of interest between the cohorts of patients with and without comorbid AiD using the chi-squared test for categorical variables, the t-test for normally distributed continuous variables, and the Mann-Whitney U test for non-normally distributed continuous variables. Factors with p<0.05 on univariable analysis were included in multivariable regression model. Statistical significance was defined as p<0.05. Independent risk factors for comorbid AiD were presented as adjusted Odds Ratios with 95% Confidence Intervals. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, North Carolina).