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Esophageal Dysmotility Is Associated With Disease Severity in Eosinophilic Esophagitis

Published:November 09, 2021DOI:https://doi.org/10.1016/j.cgh.2021.11.002

      Background & Aims

      An association of eosinophilic esophagitis (EoE) with esophageal dysmotility has been described, however, the related mechanism remains unclear. We aimed to evaluate clinical and physiologic characteristics, including esophageal distensibility, associated with secondary peristalsis in patients with EoE.

      Methods

      A total of 199 consecutive adult patients with EoE (age, 18–78 y; 32% female) who completed a 16-cm functional luminal imaging probe (FLIP) during endoscopy were evaluated in a cross-sectional study. FLIP panometry contractile response (CR) patterns were classified as normal CR or borderline CR if antegrade contractions were present, and abnormal CRs included impaired/disordered CR, absent CR, or spastic-reactive CR. The distensibility plateau of the esophageal body and esophagogastric junction distensibility was measured with FLIP.

      Results

      FLIP CR patterns included 68 (34%) normal CR, 65 (33%) borderline CR, 44 (22%) impaired/disordered CR, 16 (8%) absent CR, and 6 (3%) spastic-reactive CR. Compared with normal CRs, abnormal CRs more frequently had reduced esophageal distensibility (distensibility plateau <17 mm in 56% vs 32%), greater total EoE reference scores (median, 5; interquartile range [IQR], 3–6 vs median, 4; IQR, 3–5) with more severe ring scores, and a greater duration of symptoms (median, 10 y; IQR, 4–23 y vs median, 7 y; IQR, 3–15 y). Mucosal eosinophil density, however, was similar between abnormal CRs and normal CRs (median, 34 eosinophils/high-power field [hpf]; IQR, 14–60 eosinophils/hpf vs median, 25 eosinophils/hpf; IQR, 5–50 eosinophils/hpf).

      Conclusions

      Although normal secondary peristalsis was observed frequently in this EoE cohort, abnormal esophageal CRs were related to EoE disease severity, especially features of fibrostenosis. This study evaluating secondary peristalsis in EoE suggests that esophageal wall remodeling, rather than eosinophilic inflammatory intensity, was associated with esophageal dysmotility in EoE.

      Keywords

      Abbreviations used in this paper:

      CR (contractile response), DI (distensibility index), DP (distensibility plateau), EGJ (esophagogastric junction), EoE (eosinophilic esophagitis), EREF (eosinophilic esophagitis reference score), FLIP (functional luminal imaging probe), hpf (high-power field), HRM (high-resolution manometry), IEM (ineffective esophageal motility), IQR (interquartile range), PPI (proton pump inhibitor)
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