Esophageal Distensibility as a Measure of Disease Severity in Patients With Eosinophilic Esophagitis

Abstract

Background & Aims The aim of this study was to assess whether measurements of esophageal distensibility, made by high-resolution impedance planimetry, correlated with important clinical outcomes in patients with eosinophilic esophagitis. Methods Seventy patients with eosinophilic esophagitis (50 male, ages 18–68) underwent endoscopy with esophageal biopsy collection and high-resolution impedance planimetry using the functional lumen-imaging probe. The patients were followed prospectively for an average of 9.2 months (range 3–14 months), and the risk of food impaction, requirement for dilation; symptom severity during the follow-up period was determined from medical records. Esophageal distensibility metrics and the severity of mucosal eosinophilia at baseline were compared between patients presenting with and without food impaction and those requiring or not requiring esophageal dilation. Logistic regression and stratification assessments were used to assess the predictive value of esophageal distensibility metrics in assessing risk of food impaction, the need for dilation, and continued symptoms. Results Patients with prior food impactions had significantly lower distensibility plateau (DP) values than those with solid food dysphagia alone. Additionally, patients sustaining food impaction and requiring esophageal dilation during the follow-up period had significantly lower DP values than those who did not. The severity of mucosal eosinophilia did not correlate with risk for food impaction, the requirement for dilation during follow up, or DP values. Conclusions Reduced esophageal distensibility predicts risk for food impaction and the requirement for esophageal dilation in patients with eosinophilic esophagitis. The severity of mucosal eosinophilia was not predictive of these outcomes and had a poor correlation with esophageal distensibility.

Impaired esophageal motor function in eosinophilic esophagitis

“…To sum up, patients with EoE exhibit reduced esophageal distensibility likely secondary to esophageal wall thickening, edema and fibrosis (26,28).…”

“…2). A prospective case-control study by Nicodème et al (28) assessed the correlation between esophageal distensibility as measured by high-resolution impedance planimetry and susceptibility to food impaction and/ or need for esophageal dilation. They also compared esophageal distensibility to eosinophilia levels at the esophageal mucosa.…”

Intrabolus Pressure Has Better Correlation Than Eosinophilia with Dysphagia Severity in Fibrostenotic Eosinophilic Esophagitis: A Pilot Study

“…This instrument obtains esophageal metrics simultaneously to assess esophageal distensibility [25]. In a study by Nicodeme et al, reduced esophageal distensibility as detected by FLIP technology was associated with an increased risk for food impactions in EoE patients [26]. Future studies incorporating FLIP technology and HRM may help us better understand the role of esophageal diameter as it relates to IBP and esophageal distensibility.…”

Functional lumen imaging of the gastrointestinal tract

“…Traditional compliance measures using bag pressure versus estimated volume did not show significant differences between patients and healthy controls [43]. The same group later investigated the FLIP as a tool to predict the risk of food impaction in EoE [44]. They concluded that EoE patients had a lower maximal reachable CSA (socalled distension plateau) than controls and that this measure predicted the risk of food impaction.…”