Response to “The Association of Inflammatory Bowel Disease and Eosinophilic Esophagitis: True Link or Surveillance Artifact?

To the Editors, We thank Drs. Dai and Huang for their interest in our recent systematic review and meta-analysis examining the association of inflammatory bowel disease (IBD) and eosinophilic esophagitis (EoE).1,2 We sincerely appreciate the opportunity to address their comments below. The authors highlight the high heterogeneity in our meta-analysis (I² = 99.5% for IBD vs. controls). We agree with this limitation, which was accordingly acknowledged in our paper. Recognizing this limitation, we performed several sensitivity analyses to account for the heterogeneity, including leaving-one-out analyses, exclusion of non-cohort studies, and removal of statistical outliers, to assess the robustness of our findings. Notably, the direction and magnitude of the association remained consistent across these analyses, providing additional confidence in the validity of the pooled odds ratios despite underlying study variability. The authors also note the possibility of surveillance bias and misclassification bias that may lead to overestimates of the association between IBD and EoE. Surveillance bias may occur as patients with IBD are more likely to undergo upper endoscopies to evaluate their symptoms, and this could theoretically increase the likelihood of detecting EoE in this population. Likewise, misclassification bias in what constitutes EoE is also possible, as esophageal eosinophilia can occur in other conditions, and the diagnosis of EoE requires rigorous exclusion of alternative causes. These are legitimate concerns, and we recognized both limitations in the original paper. However, the association we observed between IBD and EoE was not disproportionately stronger for Crohn’s disease compared to ulcerative colitis, despite the latter being historically limited to the colon and thus less likely to prompt upper endoscopic evaluation. This finding may argue against surveillance and misclassification bias as explanations for the observed association between IBD and EoE. Furthermore, we included atopic dermatitis as a comparator condition to better appreciate the association between IBD and EoE compared to other autoimmune conditions. As the association between atopic dermatitis and EoE is well-established, this in effect serves as a positive control. Therefore, the consistent positive association we observed between atopic dermatitis and EoE further reinforces the validity of our methods, which were used to address the study question of whether there is an association between IBD and EoE.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.