S929 Risk of Esophageal Cancer in Patients With Eosinophilic Esophagitis Compared to Those With GERD: A Propensity Score-Matched Retrospective Cohort Study

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition increasingly recognized in recent decades. While chronic inflammation is linked to cancer risk, data on the association between EoE and esophageal cancer (EC) are limited and inconclusive. This study evaluated the 10-year risk of EC in patients with EoE compared to those with gastroesophageal reflux disease (GERD) using a large population-based dataset. Methods: We conducted a retrospective cohort study using TriNetX, a global federated health research network aggregating de-identified electronic health records. Adult patients diagnosed with EoE between April 2015 and April 2025 were identified as cases. A control cohort comprised patients with a history of GERD. One-to-one propensity score matching was used to balance demographics, alcohol use, nicotine dependence, and Barrett’s esophagus. The primary outcome was the risk of EC within 10 years. Secondary outcomes included surgical excision rates, esophageal stenting, frequency of endoscopic resections, use of esophageal dilation procedures, and all-cause mortality. Relative risk (RR) and 95% confidence intervals (CI) were calculated, and a 2-sided P-value < 0.05 was considered statistically significant. Results: Prior to matching, 93,056 patients with EoE and 8,127,510 with GERD were identified. After propensity score matching, 93,056 patients remained in each group with mean age (43.3 ± 16.4 years), female sex (41.6%), and comparable rates of nicotine dependence (6.5%), alcohol use (2.6%), and Barrett’s esophagus (2.8%). Over a 10-year follow-up, esophageal cancer developed in 99 EoE patients (0.1%) and 102 GERD patients (0.1%), with no significant difference between groups (RR 0.97; 95% CI 0.737-1.280; P = 0.836). No variation was seen across esophageal cancer subtypes. Surgical excision and stenting rates were similar, while endoscopic resections and dilation procedures were more frequent in the EoE group. All-cause mortality was higher among GERD patients. Conclusion: In this large, matched cohort study, no increased risk of esophageal cancer was observed in patients with EoE compared to those with GERD over a 10-year period. These findings are consistent with prior smaller studies and suggest that despite the chronic inflammation seen in EoE, it may not confer an elevated malignancy risk.