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

Abstract

Eosinophilic esophagitis is characterized by dysphagia with esophageal eosinophilia. We sought to determine if intrabolus pressure measurements on high-resolution manometry had any correlation with dysphagia improvement following standard therapy for patients with fibrostenotic eosinophilic esophagitis. Consecutive patients were prospectively enrolled at our swallowing center. Dysphagia scores, esophageal eosinophil counts, endoscopic reference scores, and intrabolus pressure measurements were compared at baseline and following therapy with 8 weeks of a proton-pump inhibitor and serial bougie dilation to a luminal diameter of 17 mm. Five patients were included in the study. The median age was 38 years. The average endoscopic reference score improved from 5.0 to 2.4 (p = 0.007). The mean esophageal diameter improved from 10.8 mm to 17.2 mm (p = 0.001). Dysphagia severity scores improved from a mean value of 34.2 to 10.8 (p = 0.004). Mucosal eosinophilia had no correlation with dysphagia severity. Mean intrabolus pressure improved from 21.8 mmHg to 11 mmHg (p = 0.001). There was strong correlation between a decrease in intrabolus pressure and improvement in dysphagia severity; however, this was not significant (p = 0.108). Intrabolus pressure has strong correlation with dysphagia severity following therapy for fibrostenotic eosinophilic esophagitis. Bougie dilation provides improvement in dysphagia despite persistent mucosal eosinophilia.

Assessment of Esophageal Motility in Patients With Eosinophilic Esophagitis

“…In a further prospective interventional study of the impact of serial PD, and following on from their previous work on IBP,57 Colizzo and colleagues demonstrated a fall in IBP after PD in 5 patients with symptomatic fibrostenotic EoE. This resulted in a reduction in dysphagia severity, although this finding did not reach statistical significance 62…”

“…The minority of these cases undergo preintervention assessment with manometry. Two studies assessed the impact of PD on manometric findings in EoE 24,62. Cantu et al24 performed PD in a single patient with absent peristalsis and EoE.…”

“…Two studies assessed the impact of PD on manometric findings in EoE. 24,62 Cantu et al 24 performed PD in a single patient with absent peristalsis and EoE. No change in motility was detected as a result of the intervention and the authors suggested that fibrosis was the underlying mechanism for the disturbed propagation.…”

“…This resulted in a reduction in dysphagia severity, although this finding did not reach statistical significance. 62…”