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• W3093918611 abstract "INTRODUCTION: Eosinophilic esophagitis (EoE), the leading cause of food impaction, is a multifactorial inflammatory disease of the esophagus, commonly associated with atopic diseases, such as atopic dermatitis (AD), and IgE-mediated food allergies. Esophageal dysfunction, the hallmark of EoE, often presents with food impaction and dysphagia. While studies indicate that microbiota dysbiosis and IL-13 regulation may play prominent roles in EoE development, there is still no consensus on the pathogenesis of EoE. The lack of knowledge on the onset of EoE is alarming, due to increased prevalence of EoE worldwide, particularly in males in Western countries. CASE DESCRIPTION/METHODS: We report five male physicians at various stages of training, including a medical student, surgical intern, fellow, hospitalist, and primary care physician ages 23–41, with one of the physicians having traveled internationally to work in the United States. All physicians presented with 1–3 years of intermittent solid food dysphagia without significant heartburn. They all underwent endoscopy and were found to have EoE with classic gross and histologic findings (>15 eos/hpf). There were no strictures noted, which indicated an inflammatory phenotype. The lack of strictures and the short duration of symptoms suggest a more recent onset of the disease. All male physicians had a positive clinical response to standard treatments of topical steroids, PPIs, and food elimination diet. DISCUSSION: As dysregulation of the gut microbiome has been indicated in EoE, we propose an element of dysbiosis in these physicians who frequently disinfect their hands. Several studies have revealed that standard hand hygiene procedures of handwashing and wearing gloves can cause irritation that may induce skin damage, affecting the microbiome of the hands of healthcare workers. As seen in AD, there are mutual and causative interactions between the skin and gut microbiomes. These skin-gut interactions could suggest frequent disinfection of hands as a potential risk factor for EoE, as altered hand microbiome from excessive hand hygiene potentially impacts the gut microbiome. Therefore, the widespread use of disinfectants in the community may play a role in increasing EoE prevalence. Nonetheless while changes in the microbial environment of the esophagus and intestine due to EoE have been observed and classified, the exact role of the interactions between the skin and gut flora remains to be investigated in the context of sterile environments and EoE in adults.Figure 1.: (A) and (B) depict endoscopic findings in a patient with EoE, showing linear furrows, white exudate, and mild edema.Figure 2.: Understanding the Role of Microbial Dysbiosis as a Risk Factor in EoE. Asterisk (*) indicates positive association between Western countries and identified risk factor. We propose frequent hand hygiene as a potential risk factor of EoE in healthcare workers, due to mutual interactions between skin flora and gut flora." @default.
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• W3093918611 date "2020-10-01" @default.
• W3093918611 modified "2023-10-14" @default.
• W3093918611 title "S3424 Exploring the Microbial Connection: Physicians, Dysbiosis, and Eosinophilic Esophagitis" @default.
• W3093918611 doi "https://doi.org/10.14309/01.ajg.0000715744.50883.33" @default.
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