Introduction
In functional dyspepsia (FD) and irritable bowel syndrome (IBS), both prevalent DGBIs that overlap more than expected by chance, increased tissue eosinophils and mast cells have been observed in the duodenum, and both disorders have been linked to immune activation to food antigens (1). Eosinophilic oesophagitis (EoE) is characterised by oesophageal eosinophil infiltration secondary to food antigen exposures. However, whether there is an increased risk of DGBI in EoE is unknown.
Aims & Methods
The aim of this study was to determine the relationship between adult EoE and DGBIs and other risk factors. General practice electronic medical records were sourced from the United Kingdom (UK) via The Health Improvement Network (THIN). Adult EoE and DGBIs were identified through Read codes.
Results
There were 1,061,813 unique adults available for analysis. There were 209 adult EoE cases (0.02%) with a mean age at first diagnosis of 35.7 years (SD=10.4), and 68% male.
Statistically significant univariate risk factors, symptoms, and medications for adult EoE are shown in Table 1.
For adult EoE, the multiple logistic regression model (adjusted for age and sex) identified male sex (OR: 2.93, 95%CI: 2.18-3.95, p<0.001), IBS (OR: 0.34, 95%CI: 0.20-0.57, p<0.001) and DGBIs (i.e., IBS, FD, and chronic constipation), (OR: 0.35, 95%CI: 0.24-0.50, p<0.001), allergy (OR: 1.78, 95%CI: 1.05-3.01, p=0.032), Helicobacter pylori infection (OR: 2.12, 95%CI: 1.07-4.19, p=0.031), and duodenitis (OR: 2.39, 95%CI: 1.40-4.09, p=0.001), as statistically significant independent risk factors. Additional modelling identified that adult EoE patients were more likely to take proton pump inhibitors (PPIs) (OR: 11.60, 95%CI: 6.55-20.56, p<0.001), anti-inflammatory agents (OR: 5.58, 95%CI: 3.71-8.39, p<0.001), and have a lower mortality (OR: 0.12, 95%CI: 0.03-0.48, p=0.030).
| Factors | Adult EoE
Odds Ratio, 95% CI |
| Male sex | 2.71, 2.08-3.62 |
| Age | 0.95, 0.94-0.96 |
| IBS | 0.54, 0.32-0.90 |
| H. pylori | 4.60, 2.36-8.97 |
| Allergy | 2.38, 1.67-3.40 |
| Autoimmune | 3.43, 1.10-10.73 |
| Reflux | 2.83, 2.08-3.85 |
| GI infections | 1.72, 1.08-2.76 |
| Depression | 1.37, 1.02-1.85 |
| Duodenitis | 4.41, 2.94-6.61 |
| Gastritis | 2.68, 1.76-4.07 |
| Asthma | 1.94, 1.36-2.78 |
| Rhinitis | 1.87, 1.30-2.69 |
| Achalasia | 10.18, 1.42-72.78 |
| Any FGIDs | 0.68, 0.50-0.92 |
| Antibiotics | 1.91, 1.13-3.22 |
| Anti-inflammatory Agents | 7.00, 4.67-10.50 |
| PPI | 10.94, 6.24-19.18 |
| Anti-histamine | 1.42, 1.08-1.85 |
| Mortality | 0.07, 0.01-0.31 |
Conclusion
Adult EoE cases are less likely to have IBS and DGBIs are less likely to occur, while other factors increase the risk (e.g., allergy). The main medications utilized were PPIs and anti-inflammatory agents. Adult EoE patients had a lower mortality compared to the background primary care population.
References
Ford AC, Staudacher HM, Talley NJ. Postprandial symptoms in disorders of gut-brain interaction and their potential as a treatment target. Gut. 2024;73(7):1199-1211.
Disclosure
Guy D. Eslick and Michael P. Jones have nothing to disclose. Nicholas J. Talley Disclosures: GutSee Ltd (consulting microbiome, 2025), Brown University, Agency for Health Care Research and Quality (fiber and laxation) (2024), Rome Foundation (member gastroduodenal committee) (present) Biocodex (FD diagnostic tool) (present) Microba (consulting microbiome - commencing 2025) Comvita Manuka Honey (FD trial consulting) (2025), BluMaiden outside the submitted work. In addition, Dr. Talley has a patent Nepean Dyspepsia Index (NDI) 1998, a patent Licensing Questionnaires Talley Bowel Disease Questionnaire licensed to Mayo/Talley, “Diagnostic marker for functional gastrointestinal disorders” Australian Provisional Patent Application 2021901692, ”Methods and compositions for treating age-related neurodegenerative disease associated with dysbiosis” US Patent Application No. 63/537,725.
Boards: The Gut Foundation Board (2025-present), Asia Pacific Association of Medical Editors (APAME) Board (President 2023-2025), Doctors for the Environment (Chair 2024-present), Luminal Faculty GESA (Chair) (2023-2025).
Editorial: UptoDate (Section Editor), Mayo Clinic Proceeding Associate Editor (2023-present).
Financial support: Dr. Talley is supported by funding from the National Health and Medical Research Council (NHMRC) to the Centre for Research Excellence in Digestive Health and he holds an NHMRC Investigator grant.