{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:04:13Z","timestamp":1783940653943,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease that is increasingly recognized as a systemic inflammatory condition. Its potential association with subsequent coded ocular diagnoses has not been well characterized in large-scale longitudinal studies. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, which aggregates de-identified electronic health records from multiple international healthcare systems. Adults aged \u226518 years with at least two clinical encounters between 2005 and 2024 were included. Patients with EoE (ICD-10-CM K20.0) were identified as the exposure cohort, while individuals undergoing routine health examinations without EoE served as controls. Those with prior ocular disease, malignancy, or death were excluded. Propensity score matching (1:1) was used to balance demographics, body mass index, comorbidities, medication use, and socioeconomic factors. The primary outcomes were coded ocular diagnostic categories identified using ICD-10-CM codes. To reduce the likelihood of including pre-existing conditions, ocular disease events diagnosed within 3 months after the index date were excluded from the analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated. Sensitivity analyses incorporated alternative exposure definitions, washout periods, and follow-up durations, with additional stratification by age, sex, and race. Results: After matching, 64,613 patients were included in each cohort. EoE diagnostic coding was associated with a higher subsequent occurrence of several coded ocular diagnostic categories, including visual disturbance and blindness (HR = 1.521; 95% CI: 1.383\u20131.673), disorders of refraction and accommodation (HR = 1.324; 95% CI: 1.188\u20131.474), lacrimal system disorders (HR = 1.504; 95% CI: 1.274\u20131.775), cataract (HR = 1.637; 95% CI: 1.384\u20131.935), glaucoma (HR = 1.463; 95% CI: 1.157\u20131.849), and disorders of the vitreous body and globe (HR = 1.903; 95% CI: 1.510\u20132.399). These findings should be interpreted cautiously because several outcomes, such as visual disturbance, disorders of refraction and accommodation, and ocular pain, were broad diagnostic categories and may be susceptible to detection or coding practices. Conclusions: In this large-scale EHR-based cohort study, EoE diagnostic coding was associated with a higher subsequent occurrence of several coded ocular diagnostic categories. These findings should be interpreted as exploratory associations rather than evidence of direct causal or mechanistic relationships, particularly for broad or detection-prone outcomes such as visual disturbance, disorders of refraction and accommodation, and ocular pain.<\/jats:p>","DOI":"10.3390\/life16071156","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:51:09Z","timestamp":1783936269000},"page":"1156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Eosinophilic Esophagitis and Coded Ocular Diagnoses: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5479-4063","authenticated-orcid":false,"given":"Yun-Feng","family":"Li","sequence":"first","affiliation":[{"name":"School of Medicine, Chung Shan Medical University, Taichung 402302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Jung","family":"Su","sequence":"additional","affiliation":[{"name":"Orthopedics Department, Chi-Mei Medical Center, Tainan 710004, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Chin","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Medicine, Chung Shan Medical University, Taichung 402302, Taiwan"},{"name":"Evidence-Based Medicine Center, Chung Shan Medical University Hospital, Taichung 402302, Taiwan"},{"name":"Library, Chung Shan Medical University Hospital, Taichung 402302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tien-Yun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600566, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Che","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine, Chung Shan Medical University, Taichung 402302, Taiwan"},{"name":"Division of Pediatric Gastroenterology, Children\u2019s Medical Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8897-5635","authenticated-orcid":false,"given":"Shuo-Yan","family":"Gau","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600566, Taiwan"},{"name":"Department and Graduate Institute of Business Administration, National Taiwan University, Taipei 106319, Taiwan"},{"name":"Institute of Allergology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"640","DOI":"10.15537\/smj.2023.44.7.20220812","article-title":"Eosinophilic esophagitis","volume":"44","author":"Alkhowaiter","year":"2023","journal-title":"Saudi Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.iac.2021.07.011","article-title":"Eosinophilic Esophagitis","volume":"41","author":"Lehman","year":"2021","journal-title":"Immunol. Allergy Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1053\/j.gastro.2007.08.017","article-title":"Eosinophilic esophagitis in children and adults: A systematic review and consensus recommendations for diagnosis and treatment","volume":"133","author":"Furuta","year":"2007","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e70192","DOI":"10.1111\/eci.70192","article-title":"Eosinophilic esophagitis: From pathophysiology to diagnosis, monitoring and treatment","volume":"56","author":"Bertin","year":"2026","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Licari, E., Borish, L.C., Ghosal, S., Griffiths, C., Barnes, B.H., Greenwell, A., Middleton, J.P., Teague, W.G., and McGowan, E.C. (2026). Prevalence and Predictors of Eosinophilic Esophagitis (EoE) Among Children with Severe Asthma. J. Allergy Clin. Immunol. Pract., S2213-2198(26)00182-0.","DOI":"10.1016\/j.jaip.2026.02.030"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.anai.2017.02.006","article-title":"Association between atopic manifestations and eosinophilic esophagitis: A systematic review and meta-analysis","volume":"118","author":"Arias","year":"2017","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.bpg.2015.06.011","article-title":"An allergist\u2019s perspective to the evaluation of Eosinophilic Esophagitis","volume":"29","author":"Spergel","year":"2015","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"309","DOI":"10.15403\/jgld-5409","article-title":"Analysis of the Association between Eosinophilic Esophagitis and MASLD: Retrospective, Observational, Cohort Analysis of the National Inpatient Sample 2016\u20132020","volume":"33","author":"Kohli","year":"2024","journal-title":"J. Gastrointest. Liver Dis. JGLD"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100855","DOI":"10.1016\/j.waojou.2023.100855","article-title":"Vernal keratoconjunctivitis and eosinophilic esophagitis: A rare combination?","volume":"17","author":"Artesani","year":"2024","journal-title":"World Allergy Organ. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/ACI.0000000000001097","article-title":"Where eye meets body part 2: Uniting allergy pathways in ocular and atopic disease\u2014T cells take the lead","volume":"25","author":"Borges","year":"2025","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"adv42716","DOI":"10.2340\/actadv.v105.42716","article-title":"Hidradenitis Suppurativa and Ocular Diseases: Real-world Evidence of 57,972 Patients","volume":"105","author":"Preissner","year":"2025","journal-title":"Acta Derm.-Venereol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"949","DOI":"10.7150\/ijms.93977","article-title":"Depression risk in chronic tonsillitis patients underwent tonsillectomy: A global federated health network analysis","volume":"21","author":"Chang","year":"2024","journal-title":"Int. J. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jaad.2024.10.055","article-title":"Human papillomavirus infection is associated with increased risk of new-onset hidradenitis suppurativa: A population-based cohort study","volume":"92","author":"Gau","year":"2025","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jaci.2018.10.067","article-title":"Fibrostenotic eosinophilic esophagitis might reflect epithelial lysyl oxidase induction by fibroblast-derived TNF-\u03b1","volume":"144","author":"Kasagi","year":"2019","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1038\/s41423-025-01325-3","article-title":"The cytokine CSBF inhibits the IL-17A and TNF-\u03b1 inflammatory pathways via SUSD2-ACT1 in keratinocytes and alleviates IMQ-induced psoriasis","volume":"22","author":"Li","year":"2025","journal-title":"Cell. Mol. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.jaad.2019.08.090","article-title":"Hidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis","volume":"82","author":"Goldburg","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s40257-021-00648-x","article-title":"Identifying and Treating Ocular Manifestations in Psoriasis","volume":"23","author":"Motlagh","year":"2022","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1111\/1346-8138.16062","article-title":"Risk of retinal diseases in patients with psoriasis: A population-based cohort study in Taiwan","volume":"48","author":"Dai","year":"2021","journal-title":"J. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/1346-8138.16261","article-title":"Risk of incident cataract in patients with psoriasis: A population-based cohort study","volume":"49","author":"Cheng","year":"2022","journal-title":"J. Dermatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1007\/s11064-019-02765-w","article-title":"Human 2-Oxoglutarate Dehydrogenase and 2-Oxoadipate Dehydrogenase Both Generate Superoxide\/H2O2 in a Side Reaction and Each Could Contribute to Oxidative Stress in Mitochondria","volume":"44","author":"Jordan","year":"2019","journal-title":"Neurochem. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100916","DOI":"10.1016\/j.preteyeres.2020.100916","article-title":"Inflammation in Glaucoma: From the back to the front of the eye, and beyond","volume":"83","author":"Baudouin","year":"2021","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1016\/j.jaci.2024.04.006","article-title":"Development and dysfunction of structural cells in eosinophilic esophagitis","volume":"153","author":"Laky","year":"2024","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1186\/s12974-021-02315-8","article-title":"TRPV4-induced M\u00fcller cell gliosis and TNF-\u03b1 elevation-mediated retinal ganglion cell apoptosis in glaucomatous rats via JAK2\/STAT3\/NF-\u03baB pathway","volume":"18","author":"Li","year":"2021","journal-title":"J. Neuroinflamm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1161\/CIRCRESAHA.115.306301","article-title":"Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis","volume":"118","author":"Gimbrone","year":"2016","journal-title":"Circ. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/s12951-024-02503-7","article-title":"Comprehensive dry eye therapy: Overcoming ocular surface barrier and combating inflammation, oxidation, and mitochondrial damage","volume":"22","author":"Xia","year":"2024","journal-title":"J. Nanobiotechnol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jtos.2018.11.007","article-title":"Healthcare delivery in meibomian gland dysfunction and blepharitis","volume":"17","year":"2019","journal-title":"Ocul. Surf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40168-015-0085-6","article-title":"Inflammation-associated microbiota in pediatric eosinophilic esophagitis","volume":"3","author":"Benitez","year":"2015","journal-title":"Microbiome"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Li, J.J., Yi, S., and Wei, L. (2020). Ocular Microbiota and Intraocular Inflammation. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.609765"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1007\/s12016-018-8697-9","article-title":"The Role of the Environment in Eosinophilic Esophagitis","volume":"57","author":"Dowling","year":"2019","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s12016-019-08733-0","article-title":"Allergic Comorbidity in Eosinophilic Esophagitis: Mechanistic Relevance and Clinical Implications","volume":"57","author":"Capucilli","year":"2019","journal-title":"Clin. Rev. Allergy Immunol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1156\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:04:28Z","timestamp":1783937068000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["life16071156"],"URL":"https:\/\/doi.org\/10.3390\/life16071156","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]}}}