High‐resolution manometry in patients with eosinophilic esophagitis under topical steroid therapy—a prospective observational study (<scp>HIMEOS</scp>‐study)

Nennstiel, Simon; Bajbouj, Monther; Becker, Valentin; Slotta‐Huspenina, Julia; Wagenpfeil, Stefan; Schmid, Roland M.; Schlag, Christoph

doi:10.1111/nmo.12753

Cited by 49 publications

(68 citation statements)

References 28 publications

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“…For EoE patients with esophageal dysmotility, local or systemic steroid treatment is administered, and consequent improvement in esophageal dysmotility is seen in most patients (22). In addition, a prospective observation study (HIMEOS study) that investigated the effect of budesonide treatment on esophageal dysmotility diagnosed based on HRM was recently reported (23). In patients with esophageal dysmotility and increased intrabolus pressure, esophageal dysmotility reportedly improved after budesonide treatment; however, no marked change was seen in the various parameters of the Chicago classification.…”

Section: Discussionmentioning

confidence: 99%

Markedly Effective Steroid Treatment of Three Patients with Allergy-related Jackhammer Esophagus

et al. 2020

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We experienced marked efficacy with steroid treatment of three patients with jackhammer esophagus (JHE). An esophageal biopsy revealed eosinophilic esophagitis (EoE) in two patients. One of the patients without EoE had eosinophilia and an increased serum immunoglobulin E level, and endoscopic ultrasonography revealed thickening of the esophageal muscularis propria. Esophageal manometry was used to diagnose all cases of JHE. Treatment consisted of steroid administration, which improved the symptoms and resolved the esophageal muscularis propria thickening in all patients. The esophageal manometry findings also normalized following treatment. Allergic diseases, including EoE, were assumed to have caused JHE.

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Section: Discussionmentioning

confidence: 99%

Markedly Effective Steroid Treatment of Three Patients with Allergy-related Jackhammer Esophagus

et al. 2020

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“…Of the 22 studies selected from European centers, 12 studies (55%) considered values within the range 11 to ≤15 eosinophils/hpf 17, 36, 37, 38, 39, 46, 47, 53, 54, 55, 56, 57, 58 as histological remission, and 4 studies (23%) defined histological remission as less than 5 or ≤ 5 eosinophils/hpf 30, 33, 42, 45. Strikingly, all studies conducted in Switzerland used a more stringent and consistent end‐point of <5 eosinophils /hpf to identify cases of histological remission 28, 59, 60…”

Section: Resultsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinophils per microscopic high‐powered field [hpf]) remain the most common end‐point used to define response. Yet, the threshold for defining “response” and “remission” are ill‐defined among consensus guidelines and may vary from study to study. We conducted a systematic literature review of articles on eosinophilic esophagitis, published between January 2007 and November 2017, considering histological remission as the primary outcome. We abstracted treatment information and definitions of histological remission or response. A comparison of definitions of histological remission across and within institutions was performed. A total of 61 articles were included in this review, with approximately 60% of the studies published from centers in the United States. Histological definitions of remission of EoE ranged from 0 to ≤20 eosinophils/hpf. The most stringent criteria, ranging from 0 to ≤5 eosinophils/hpf, were commonly used in interventional trial studies that examined the effects of new treatments. We found remarkable variability in definitions between studies, treatment types, and regions. Age or epidemiological distribution of study subjects did not influence the criteria for histological remission. Clinical and histological improvements are important measures of the effects of treatment. Histological findings, the most objective measure of treatment, should provide an optimal method for comparing the effectiveness of various treatments. Yet, our findings suggest a lack of consistent remission criteria in published studies. Considering these inconsistencies, it is difficult to compare the effectiveness of various treatments.

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“…Although esophageal motility disorders occurred more frequently in patients with EoE than in control groups, both frequency and type of described manometric irregularities were similar to those observed in patients with GERD [23,24], and in the case of patients with PPI-REE proved to be nearly identical, which might indicate that both diseases share similar pathogenetic mechanisms [29]. Yet, as opposed to patients with GERD, patients with EoE are symptomatically more prone to exposure to abnormal bolus pressurization in the esophagus (20-48%), such as early pan-esophageal pressurizations (15-17%) or compartmentalized esophageal pressurizations (5-19%) [23,26,28]. It was specified that pan-esophageal pressurizations correlate with episodes of bolus impaction in this group of patients, but do not correlate with dysphagia occurrence [28].…”

Section: High-resolution Manometrymentioning

confidence: 93%

“…It is estimated that irregularities in the manometric record occur in 20-76% of patients with EoE [23][24][25][26][27][28][29]. Among motility disorders mentioned in Chicago classification criteria the most frequently quoted were the patterns of weak peristalsis (17-27%), frequent failed peristalsis (7-12%) [23][24][25][26][27], as well as functional esophagogastric junction (EGJ) obstruction, rapid contraction with normal latency, absent peristalsis, hypertensive peristalsis [23], or even Jackhammer esophagus [25]. Although esophageal motility disorders occurred more frequently in patients with EoE than in control groups, both frequency and type of described manometric irregularities were similar to those observed in patients with GERD [23,24], and in the case of patients with PPI-REE proved to be nearly identical, which might indicate that both diseases share similar pathogenetic mechanisms [29].…”

Section: High-resolution Manometrymentioning

confidence: 99%

High-resolution manometry in diagnostics and evaluation of therapy effectiveness in patients with eosinophilic esophagitis – underestimated breakthrough or dead end?

Sarbinowska¹,

Waśko−Czopnik²

2020

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Eosinophilic esophagitis (EoE) is a chronic disease with non-specific symptoms, among which dysphagia is a prevailing one. The observed increase of EoE rate, its chronic and recurrent character, as well as invasive follow-up examination (periodical panendoscopy with specimen collection for histopathology), compel optimization of both the diagnostics algorithm and disease monitoring through searching for new, unique methods and tools so far not applied, including high-resolution manometry (HRM). Mentioned investigations result from advances in comprehension of disease pathogenesis, in which it is suggested that development of a chronic inflammatory reaction of the esophageal wall may lead to consecutive fibrosis and motility disorders. In research published to date one manometric pattern characteristic for EoE was not obtained, whereas the obtained inconsistent and at times contradictory results do not correlate either with symptoms exacerbation or endoscopic scan. Numerous constraints of discussed studies as well as current knowledge in disease etiopathology and esophagus biomechanics prompt further investigation of HRM significance in diagnostics and therapy monitoring of patients with EoE. High-resolution manometry in diagnostics and evaluation of therapy effectiveness in patients with eosinophilic esophagitisunderestimated breakthrough or dead end?

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High‐resolution manometry in patients with eosinophilic esophagitis under topical steroid therapy—a prospective observational study (HIMEOS‐study)

Cited by 49 publications

References 28 publications

Markedly Effective Steroid Treatment of Three Patients with Allergy-related Jackhammer Esophagus

Markedly Effective Steroid Treatment of Three Patients with Allergy-related Jackhammer Esophagus

Systematic review of histological remission criteria in eosinophilic esophagitis

High-resolution manometry in diagnostics and evaluation of therapy effectiveness in patients with eosinophilic esophagitis – underestimated breakthrough or dead end?

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