Oesophageal narrowing is common and frequently under‐appreciated at endoscopy in patients with oesophageal eosinophilia

Gentile, Nicole; Katzka, David A.; Ravi, Karthik; Trenkner, Stephen W.; Enders, Felicity; Killian, Jill M.; Kryzer, Lori A.; Talley, Nicholas J.; Alexander, Jeffrey A.

doi:10.1111/apt.12977

Cited by 128 publications

(89 citation statements)

References 12 publications

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“…Studies have determined the barium esophagram often detects symptomatic esophageal narrowing not recognized on endoscopy. The Mayo group observed that endoscopy, when compared to a detailed barium esophagram, had poor sensitivity (25%) in defining strictures in the symptomatic range from 10 to 15 mm diameter [11]. We agree and therefore routinely carefully dilate all patients with EoE to assess the true lumen diameter defined by the bougie size at which resistance is noted with passage of Savary or Maloney dilators.…”

Section: Discussionmentioning

confidence: 91%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 91%

“…One clinical difficulty is assessing the severity of fibrosis. This feature is often challenging to appreciate with conventional endoscopy, which poorly assesses esophageal narrowing in the range of 10 to 15 mm [9,11].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Early meta-analysis of 100 studies showed poor sensitivity (15-48%) and high specificity (90-95%) of these findings [52]. A new validated scoring system, the EoE Endoscopic Reference Score (EREFS), has been tested and validated across expert and non-expert endoscopists, which should help standardize these features across all EoE patients [53].…”

Section: Diagnosismentioning

confidence: 99%

“…Acid suppression has been a frequent medication prescribed for EoE, as a significant amount of patients have responded histologically and clinically [53]. As mentioned earlier, there are studies in adults that show PPI therapy to be effective in reducing clinical and histological symptoms in patient with "EoE phenotype" (50%) and in patient with negative pH monitoring studies (33%) [23].…”

Section: Acid Suppressionmentioning

confidence: 99%

Eosinophilic Esophagitis: A Comprehensive Review

Nt¹

2016

J Hepatol Gastroint Dis

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Eosinophilic Esophagitis (EoE) has been the subject of intense research and study over the past few years, as incidence and prevalence has increased in the United States, especially in adults. The signs, symptoms and complications of EoE arise from a complex interplay of genetic predisposition and environmental exposure that is not understood well at this time. The disease causes significant morbidity in both physical and psychological areas, and these effects may become permanent in some cases where remodeling of the epithelium is present. Treatment at this time mainly focuses on diet, medication and endoscopic dilation. While none of these entities can accomplish all of the treatment goals, careful selection of patients based on symptoms and physical findings can alleviate many of the complications of the disease. In addition, this review attempts to cull data from adult studies if possible, as much of the studies that involved children did not translate well to adult patients.

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“…Gentile et al 1 report a fascinating study demonstrating how endoscopists commonly overlook the presence of oesophageal luminal compromise in patients with symptomatic oesophageal eosinophilia. Fifty-eight patients, without impaired passage of a standard diagnostic adult endoscope, were evaluated with a barium swallow, including detailed measurements of intraluminal diameter.…”

mentioning

confidence: 99%

Editorial: expanding a narrow perspective on narrow calibre oesophagus in eosinophilic oesophagitis

Molina–Infante

Hirano

2014

Aliment Pharmacol Ther

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Oesophageal narrowing is common and frequently under‐appreciated at endoscopy in patients with oesophageal eosinophilia

Abstract: Symptomatic oesophageal narrowing identified by barium oesophagography is common and under-recognised at endoscopy in patients with oesophageal eosinophilia.

Cited by 128 publications

References 12 publications

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

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

Eosinophilic Esophagitis: A Comprehensive Review

Editorial: expanding a narrow perspective on narrow calibre oesophagus in eosinophilic oesophagitis

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