Risk of Cancer Diagnosis in Patients With Eosinophilic Esophagitis Using a Nationwide Swedish Population Cohort

Amiko M Uchida; Sophia S Schuman; Ashley Pyne; Kathryn Peterson; Marie Carlson; John J Garber; Bjorn Roelstraete; Jonas F Ludvigsson

doi:10.1002/ueg2.12713

Risk of Cancer Diagnosis in Patients With Eosinophilic Esophagitis Using a Nationwide Swedish Population Cohort

United European Gastroenterol J. 2024 Nov 20. doi: 10.1002/ueg2.12713. Online ahead of print.

Authors

Amiko M Uchida¹, Sophia S Schuman¹, Ashley Pyne¹, Kathryn Peterson¹, Marie Carlson², John J Garber³, Bjorn Roelstraete⁴, Jonas F Ludvigsson^{4

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Affiliations

¹ Division of Gastroenterology, Hepatology & Nutrition, University of Utah School of Medicine, Salt Lake City, Utah, USA.
² Gastroenterology Research Group, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
³ Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Pediatrics, Örebro University, Örebro, Sweden.
⁶ Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, New York, USA.

PMID: 39565026
DOI: 10.1002/ueg2.12713

Abstract

Background: Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus. Chronic inflammation has been linked to cancer development. We aimed to study the potential association between EoE and later cancer diagnosis.

Methods: In this nationwide population-based cohort study, we identified 1580 individuals with EoE diagnosed between 1990-2017 through Sweden's 28 pathology departments. Up to five general population reference individuals were matched on age and sex (n = 7533). A Cox regression analysis estimated adjusted hazard ratios (aHRs) for cancer up until December 31, 2020. To reduce potential intrafamilial confounding, we also compared EoE individuals with their unaffected siblings.

Results: During a median follow-up of 7 years, 47 individuals with EoE (3.9/1000 person-years) developed cancer versus 183 (3.2/1000 person-years) reference individuals. This corresponded to a non-significant aHR of 1.11 (95% CI = 0.80-1.53). Incidence rates were independent of budesonide and proton-pump inhibitor use. Individuals with EoE however did have an increased risk of esophageal cancer where two EoE versus one reference individual were diagnosed (aHR = 25.20; 95% CI = 2.28-278.80), and also Barrett's esophagus risk was also increased in EoE (HR = 18.18; 95% CI = 6.75-48.95). Non-esophageal gastrointestinal (GI) cancer occurred in 11 EoE versus 24 reference individuals: aHR = 2.03 (95% CI = 0.99-4.18). We found no increased risk of cancers from the skin (EoE n = 10), lung (n = 0), breast (n = 4), or blood (n = 0). Sibling analyses supported these findings.

Conclusion: We did not find any overall association between EoE and cancer development. EoE was associated with esophageal cancer, but this was very rare with wide confidence interval and few cases therefore we urge caution with generalization of these findings.

Keywords: Barrett's esophagus; EoE; allergy; autoimmunity; epidemiology; esophageal cancer; inflammation; malignancy; onset; risk factor.

Abstract

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