Helicobacter pylori as a potential cause of reversible esophageal eosinophilia

Purpose Helicobacter pylori (HP) infects up to half of the global population, though its prevalence is declining due to improved hygiene and eradication therapies. In contrast, eosinophilic esophagitis (EoE) incidence is rising, potentially linked to the hygiene hypothesis. Studies suggest an inverse relationship between HP and EoE, but esophageal eosinophilia (EE) can arise from various causes, including infections. The aim of this study was to examine the association between HP and EE and the effect of HP eradication. Methods We conducted a retrospective observational study of patients aged 1–21 years diagnosed with EE (> 15 eosinophils/high power field [HPF]) between 2019 and 2024 at Shamir Medical Center, Israel. Gastric biopsies confirmed HP infection, followed by eradication therapy and repeat endoscopy. Data included demographics, medical history, endoscopic findings, HP eradication success, and esophageal histology. Results Among 97 patients with EE, 70.1% were male, and the mean age was 10.46 ± 5.79 years. HP infection was present in 23 (23.7%) patients, with successful eradication in 11 (47.8%). Basal cell hyperplasia (BCH) was more frequent in HP-positive patients (60.9% vs. 36.5%, P = 0.039). Other features were similar. EE resolved in 4 (36.4%) of successfully eradicated patients. Patients with EE resolution were younger, less likely male, and had fewer atopic conditions. Conclusions HP infection may contribute to esophageal epithelial remodeling as indicated by increased BCH. In some children, HP-associated EE may be reversible. HP diagnosis and eradication should be considered before confirming EoE, particularly in younger patients with mild eosinophilia and no macroscopic EoE findings.