Burden of Eosinophilic Esophagitis and Gastroesophageal Reflux Disease in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Comprehensive US Healthcare Analysis.

BACKGROUND

Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) share several risk factors with metabolic dysfunction-associated steatotic liver disease (MASLD). However, the relationship between these conditions remains unclear. This study aimed to investigate the association between MASLD and EoE, as well as GERD and its phenotypes.

METHODS

We conducted a population-based study using the TriNetX US Collaborative Network, analyzing adult patients (≥ 18 years) with and without MASLD. Propensity score matching (PSM) (1:1) was performed to adjust for demographics and clinical characteristics. The primary outcome was incident EoE. Secondary outcomes included GERD and its phenotypes such as nonerosive reflux disease (NERD), erosive esophagitis (EE), and Barrett's esophagus (BE).

RESULTS

Following PSM, a total of 266 980 patients (18-44 years), 385 138 (45-64 years), and 150 640 (≥ 65 years) were included in the analysis. MASLD was strongly associated with increased odds of EoE across all age groups: 18-44 years (OR = 2.905; 95% CI 2.458-3.434), 45-64 years (OR = 2.423; 95% CI 2.057-2.854), and ≥ 65 years (OR = 2.327; 95% CI 1.606-3.371). Similarly, GERD, NERD, EE, and BE were associated with significantly higher odds among patients with MASLD across all age strata.

CONCLUSION

Our findings demonstrate a significant association between MASLD and EoE, as well as increased odds of GERD phenotypes in patients with MASLD. These associations highlight the need for further research to explore shared pathophysiological mechanisms and potential clinical implications.