Esophageal Distensibility Defines Fibrostenotic Severity in Pediatric Eosinophilic Esophagitis

Hoffmann, Natalie V.; Keeley, Kaitlin; Wechsler, Joshua B.

doi:10.1016/j.cgh.2022.08.044

Cited by 18 publications

(10 citation statements)

References 23 publications

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“…Eosinophil in ltrate density has been shown not to predict outcomes in patients with EoE. In contrast, esophageal distension capacity, which does not correlate with eosinophil density 13 may de ne brostenotic severity and clinical outcomes 20 . Patients with reduced distension capacity are at risk of food impactions, as a reduced esophageal compliance (< 225mm 2 ) was shown as good predictor for esophageal food bolus impaction and the need for esophageal dilatation.…”

Section: Discussionmentioning

confidence: 98%

A New Method to Evaluate Lower Esophageal Distension Capacity in Eosinophilic Esophagitis by using functional lumen imaging probe (Endoflip™)

Casabona-Francés,

Sanz-García,

Ortega

et al. 2023

Preprint

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Background Endoluminal functional lumen impedance planimetry (EndoflipTM) has become the gold standard to evaluate esophageal distensibility, although the study itself and its analysis present challenges. We propose here a new method to assess lower esophageal distension capacity, which overcomes several limitations of prior approaches including incomplete and corrupted EndoflipTM recordings. Methods Esophageal distension capacity was evaluated with a 16-channel EndoflipTM in 10 controls and 14 patients with Eosinophilic Esophagitis (EoE). Controls were evaluated once. EoE patients were evaluated at baseline and after at least six weeks treatment with budesonide orodispersible tablet 1mg bd. Balloon volumes were increased 5-mL stepwise either reaching maximum volume of 60 mL, or maximum balloon pressure of 60mmHg. Recordings were analyzed with a home-made R script. The mean esophageal diameter at 60 mL D(60mL) was calculated or extrapolated depending on whether the 60 mL volume was reached. Results By fitting a Michaelis-Menten curve across all measured diameters throughout all constant volume steps, mean D(60mL) was estimated. For control subjects, the mean±SD value of diameter at D(60mL) was 17.08±1.69 mm and for EoE patients at baseline D(60mL) was 14.51±2.68 mm. After six weeks of treatment of EoE patients, D(60mL) significantly increased to 16.22±1.86mm (paired Wilcoxon signed test: p=0.0052), although the values for control subjects were not reached. Conclusions Estimated mean esophageal diameter at 60 mL is a good proxy for esophageal distension capacity, which correlates with clinical outcomes in EoE. The method presented in this study overcome difficulties encountered during the standard measurement protocol, allowing analysis of recordings from incomplete and corrupted registries.

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Section: Discussionmentioning

confidence: 98%

A New Method to Evaluate Lower Esophageal Distension Capacity in Eosinophilic Esophagitis by using functional lumen imaging probe (Endoflip™)

Casabona-Francés,

Sanz-García,

Ortega

et al. 2023

Preprint

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“…Reduced oesophageal distensibility is reported in both children and adults with EoE and is associated with increased risk of food bolus impaction and the need for oesophageal dilatation[ 40 , 44 ]. Distensibility is also significantly reduced in children with active EoE compared to an age matched control and the natural increase in oesophageal distensibility normally observed with age, appeared to plateau in children with EoE[ 44 , 45 ]. This may represent a fibrotic remodelling or a separate EoE phenotype[ 44 ].…”

Section: Introductionmentioning

confidence: 99%

“…Distensibility is also significantly reduced in children with active EoE compared to an age matched control and the natural increase in oesophageal distensibility normally observed with age, appeared to plateau in children with EoE[ 44 , 45 ]. This may represent a fibrotic remodelling or a separate EoE phenotype[ 44 ]. Figure 2B is a child with EoE and reduced diameter/distensibility.…”

Section: Introductionmentioning

confidence: 99%

“…In paediatrics, a reduced oesophageal distensibility was reported in children with EoE and high endoscopic reference score part of (EREF)[ 44 ]. In EREF, rings and strictures are considered as features of fibrosis and remodelling changes, while oedema, furrows and exudates are considered as features of inflammatory changes[ 46 ].…”

Section: Introductionmentioning

confidence: 99%

“…In EREF, rings and strictures are considered as features of fibrosis and remodelling changes, while oedema, furrows and exudates are considered as features of inflammatory changes[ 46 ]. It is increasingly recognised that inflammatory features can progress to fibrosis and remodelling in the context of EoE and although children can predominantly present with inflammatory EoE phenotype, early fibrosis in paediatric patients is commonly described[ 44 , 45 ]. Oesophageal DI, but not CSA or diameter, has a strong correlation with endoscopic fibrostenotic severity and history of food bolus impaction in paediatrics independent of age, height or oesophageal inflammation[ 44 ].…”

Section: Introductionmentioning

confidence: 99%

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Use of endolumenal functional lumen imaging probe in investigating paediatric gastrointestinal motility disorders

White,

Mutalib

2023

World J Clin Pediatr

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Investigating gastrointestinal (GI) motility disorders relies on diagnostic tools to assess muscular contractions, peristalsis propagation and the integrity and coordination of various sphincters. Manometries are the gold standard to study the GI motor function but it is increasingly acknowledged that manometries do not provide a complete picture in relation to sphincters competencies and muscle fibrosis. Endolumenal functional lumen imaging probe (EndoFLIP) an emerging technology, uses impedance planimetry to measure hollow organs cross sectional area, distensibility and compliance. It has been successfully used as a complementary tool in the assessment of the upper and lower oesophageal sphincters, oesophageal body, the pylorus and the anal canal. In this article, we aim to review the uses of EndoFLIP as a tool to investigate GI motility disorders with a special focus on paediatric practice. The majority of EndoFLIP studies were conducted in adult patients but the uptake of the technology in paediatrics is increasing. EndoFLIP can provide a useful complementary data to the existing GI motility investigation in both children and adults.

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Manometric findings in children with eosinophilic esophagitis and persistent post‐remission dysphagia

Yogev,

Dorfman,

Mansi

et al. 2024

JPGN rep.

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ObjectivesDysphagia is a frequent symptom of active eosinophilic esophagitis (EoE), but at times it persists despite attaining histologic healing and lack of fibro‐stenotic changes. We aimed to describe the manometric findings in this subset of patients.MethodsA retrospective review of charts between 2013 and 2023 at a tertiary pediatric gastroenterology center, treating roughly 1500 EoE patients per year. We included children with EoE referred to high‐resolution impedance manometry (HRIM) for persistent dysphagia despite histologic healing (i.e., <15 Eos/hpf). Data including initial EoE diagnosis, endoscopy reports, esophageal biopsies, treatment regimens, and HRIM were retrospectively collected.ResultsThe estimated prevalence of post‐remission dysphagia in our cohort was exceedingly rare (<0.05%). Four patients met the eligibility criteria of histologic remission and absence of fibro‐stenotic features on endoscopic evaluation and thus, were included in this case series. Patients achieved remission with steroids, proton‐pump inhibitor, or both within a median time of 5 months from diagnosis. Peak Eosinophil count at remission was ≤5 Eos/hpf in three patients and ≤10 Eos/hpf in one. On HRIM, all four patients had a hypomotile esophagus and abnormal bolus clearance. Lower esophageal sphincter integrated relaxation pressure values were normal in three patients and elevated in one. Two patients were diagnosed with ineffective esophageal motility, one with aperistalsis and one with achalasia type 1.ConclusionsPost‐remission dysphagia is rare in EoE. Esophageal dysmotility with a hypomotile pattern may contribute to the persistent dysphagia in children with EoE. HRIM should be considered in patients with EoE in whom symptoms persist despite histologic remission.

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Esophageal Distensibility Defines Fibrostenotic Severity in Pediatric Eosinophilic Esophagitis

Cited by 18 publications

References 23 publications

A New Method to Evaluate Lower Esophageal Distension Capacity in Eosinophilic Esophagitis by using functional lumen imaging probe (Endoflip™)

A New Method to Evaluate Lower Esophageal Distension Capacity in Eosinophilic Esophagitis by using functional lumen imaging probe (Endoflip™)

Use of endolumenal functional lumen imaging probe in investigating paediatric gastrointestinal motility disorders

Manometric findings in children with eosinophilic esophagitis and persistent post‐remission dysphagia

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