TY  - JOUR
T1  - Eosinophilic Esophagitis with Concurrent Gastric Helicobacter pylori Infection: An Underappreciated Clinicopathologic Association 
AU  - Zhou, Jing
AU  - Jiang, Katrina J.
AU  - Xin, Wei
JF  - Journal of Clinical and Translational Pathology
VL  - 
IS  - 000
SN  - 2771-165X
SP  - 
EP  - 
Y1  - 2026-09-30
DO  - 10.14218/JCTP.2026.00021
UR  - https://www.xiahepublishing.com/2771-165X/JCTP-2026-00021
AB  - Background and objectives 
Eosinophilic esophagitis (EoE) is characterized by esophageal dysfunction and ≥15 eosinophils/high-power field on biopsy. The specific clinicopathologic characteristics and therapeutic outcomes of patients with concurrent gastric Helicobacter pylori infection and EoE remain poorly defined. This observational cohort study reexamines this relationship and evaluates the clinicopathologic features and outcomes of patients with concurrent diseases.
Methods
We retrospectively reviewed esophageal and gastric biopsies obtained between January 1, 2022, and December 30, 2025. Patients with a first-time diagnosis of EoE and concurrent treatment-naive gastric H. pylori infection were identified and confirmed by morphology and immunohistochemistry. Patients with a history of prior H. pylori eradication therapy or eosinophilic gastrointestinal disease were excluded. Clinical, pathologic, and follow-up data were analyzed.
Results
Among 5,443 patients undergoing concurrent esophageal and gastric biopsy evaluation, 197 (3.6%, 95% confidence interval [CI], 3.1–4.1%) met the diagnostic criteria for EoE, and 286 (5.3%, 95% CI, 4.7–5.9%) had gastric H. pylori infection. Twenty-eight patients with concurrent EoE and gastric H. pylori infection were initially identified, corresponding to an H. pylori prevalence of 14.2% (28/197) among patients with EoE. A significant association was identified between EoE and H. pylori infection (odds ratio, 3.20; 95% CI, 2.11–4.87; Fisher’s exact test, P < 0.001). After exclusion of 1 patient with eosinophilic gastrointestinal disease and 3 patients with prior H. pylori treatment, 24 patients met the study inclusion criteria for the subsequent clinicopathologic analysis. Among these 24 patients (M:F = 7:1; mean age, 29.5 years; range, 8–82 years), 8 (33%) were children. The most common presentations (n = 18, 75%) were abdominal pain in children and dysphagia in adults. Atopy was present in 7 (29%) patients. Histologically, 5 (21%) cases exhibited classic features, while 19 (79%) showed nonclassic features with lower eosinophil density and a more uniform distribution of eosinophils within the epithelium. Among 10 patients with follow-up, 3/10 (30%) achieved resolution of both H. pylori infection and EoE after H. pylori eradication therapy with or without steroids; 5/10 (50%) had persistent H. pylori infection and persistent or recurrent EoE; 2(20%) achieved H. pylori-negative status but had persistent EoE; and fungal infection developed in 2 of 4 patients (50%) treated with steroids.
Conclusions
H. pylori infection may be associated with a nonclassic pattern of EoE. Recognition of this pattern may have implications for diagnosis and management.