S976 Revisiting the Relationship Between Eosinophilic Esophagitis and Barrett’s Esophagus: Evidence From a Nationally Representative Cohort

Introduction: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease marked by eosinophilic infiltration of the esophagus. It was once considered a manifestation of gastroesophageal reflux disease (GERD) but is now recognized as a distinct entity based on clinical, endoscopic, and histologic features. Although both affect the esophagus, Barrett’s esophagus (BE), a premalignant outcome of chronic reflux, differs in pathophysiology. Studies report conflicting associations between EoE and BE. This study examines their relationship using the National Inpatient Sample (NIS). Methods: We performed a cross-sectional analysis of adults (≥18 years) using the 2016-2019 NIS database. The primary outcome was BE, with EoE as the main exposure. Multivariable logistic regression adjusted for age, sex, race, GERD, obesity, and smoking. Survey weights were applied. Sensitivity analyses included GERD-only patients and stratification by age and sex. Results: In a cohort of 120,578,175 weighted hospitalizations, 16,280 were identified as having EoE, while 492,770 were diagnosed with BE. The prevalence of EoE among individuals without BE was determined to be 0.0135%. In an unadjusted analysis, EoE was found to be significantly associated with an increased likelihood of BE, yielding an odds ratio of 6.39 (95% CI 5.15-7.93; P < 0.0001). Following adjustment for confounding variables like age, sex, race, GERD, obesity, and smoking, EoE continued to demonstrate a significant association with BE, with an adjusted odds ratio (aOR) of 5.39 (95% CI 4.28-6.78, P < 0.0001). In the sensitivity analysis restricted to patients with GERD, EoE remained independently associated with BE (aOR 3.5; 95% CI 2.32-5.18; P < .0001). The association between EoE and BE remained consistent across different demographic subgroups. Conclusion: Our analysis of a large national cohort revealed a strong, independent association between EoE and BE, even after adjusting for shared risk factors like GERD, obesity, and smoking. This contrasts with earlier studies suggesting a protective role of EoE against BE, possibly due to differences in population size, design, or diagnostic criteria. The persistence of the association in GERD-only patients suggests EoE may confer additive risk beyond acid exposure alone. These findings challenge the notion that EoE and BE are mutually exclusive and highlight the need for further research to elucidate the mechanisms linking these 2 esophageal diseases.