Prevalence of esophageal dysmotility in a cohort of patients with esophageal biopsies consistent with eosinophilic esophagitis

Bassett, John T.; Maydonovitch, Corinne; Perry, Joseph L.; Sobin, Leslie H.; Osgard, Eric M.; Wong, Roy K.H.

doi:10.1111/j.1442-2050.2009.00949.x

Cited by 36 publications

(35 citation statements)

References 28 publications

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“…This finding is in line with previous manometric data suggesting that contractile activity of the circular muscle is relatively normal in EoE. 22-29 Thus, it appears that the defect is fixed at the extreme of distention, but the esophageal wall is still collapsible and amenable to contraction.…”

Section: Discussionsupporting

confidence: 91%

Mechanical Properties of the Esophagus in Eosinophilic Esophagitis

et al. 2011

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Background and Aim This study aimed to analyze the mechanical properties of the esophagus in eosinophilic esophagitis (EoE) using the functional luminal imaging probe (EndoFLIP®, Crospon Medical Devices, Galway, Ireland). Methods 35 EoE patients (24M, 23-67y) and 15 controls (6M, 21–68y) were included. Subjects were evaluated during endoscopy with the EndoFLIP® probe comprised of a compliant cylindrical bag (maximal diameter 25mm) with 16 impedance planimetry segments. Stepwise bag distensions from 2 to 40mL were conducted and the associated intra-bag pressure and intra-luminal geometry were analyzed. Results The EndoFLIP® clearly displayed the tubular esophageal geometry and detected esophageal narrowing and localized strictures. Stepwise distension progressively opened the esophageal lumen until a distension plateau was reached such that the narrowest cross-sectional area (CSA) of the esophagus maximized despite further increases in intra-bag pressure. The esophageal distensibility (CSA vs. pressure) was reduced in EoE patients (p=0.02) with the distension plateau of EoE patients substantially lower than that of controls (median CSA 267 vs. 438 mm2, p<0.01). Neither mucosal eosinophil count, age, gender, nor current PPI treatment predicted this limiting caliber of the esophagus (p≥0.20). Conclusion Esophageal distensibility, defined by the change in the narrowest measurable CSA within the distal esophagus vs. intra-luminal pressure, was significantly reduced in EoE patients compared to controls. Measuring esophageal distensibility may be an important adjunct to the management of EoE as it is capable of providing an objective means to measure the outcome of medical or dilation therapy.

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Section: Discussionsupporting

confidence: 91%

Mechanical Properties of the Esophagus in Eosinophilic Esophagitis

et al. 2011

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“…Similarly, in one series, 58% (7/12) of adults with EoE presenting with dysphagia had coexisting esophageal motor disturbances [6]. In contrast, other studies, including one undertaken at our institution [8], demonstrated that only a small number of EoE patients have coexisting esophageal motor disorders [9,10], which implies that esophageal motor disorders are less likely to be a major contributing factor to dysphagia, the predominant clinical symptom of EoE. This discrepancy may in part be due to the small number of patients evaluated, the varying definitions of esophageal motility disorders that exist in the literature, and the methodology used to compare symptoms to manometric findings.…”

Section: Introductionmentioning

confidence: 90%

Esophageal Motor Disorders in Adults with Eosinophilic Esophagitis

et al. 2011

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“…34 54,55 and dysfunction of the longitudinal muscles have been observed. 56 Reduced oesophageal compliance was recently reported; 57 however, how this is associated with symptoms is unclear.…”

Section: Safety and Potential Complicationsmentioning

confidence: 99%

Review article: oesophageal dilation in adults with eosinophilic oesophagitis

Bohm

Richter

2011

Alimentary Pharmacology &Amp; Therapeutics

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Alimentary Pharmacology and Therapeutics INTRODUCTIONEosinophilic oesophagitis (EoO) is a chronic inflammatory disorder of the oesophagus characterised by the proton pump inhibitor-refractory accumulation of eosinophils in the oesophageal epithelium [>15 intraepithelial eosinophils ⁄ high powered field (eos ⁄ hpf)] in combination with a range of symptoms including dysphagia, food impaction, chest pain, abdominal pain and vomiting. [1][2][3] The clinical manifestations of EoO vary with age. Nearly all adults complain of solid food dysphagia with many being 'slow eaters' who meticulously chew their food. More than 50% give a history of food impaction.The endoscopic features of EoO suggest a chronic disease with inflammatory features of furrows, microabscesses and plaques seen predominantly in paediatric patients and oesophageal remodelling characterised by the narrow calibre oesophagus, strictures and ring formation more commonly seen in adult EoO patients. Most likely these changes are progressive in nature, but this is a speculation yet to be defined with serial studies from childhood to adulthood. The treatments for these early inflammatory changes are anti-inflammatory medications (swallowed fluticasone, budesonide, prednisone) or restrictive and elemental diets. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] On the other hand, adult EoO patients typically show less active inflammation and more fibrotic changes due to collagen deposition in the epithelium and submucosa. Straumann et al. 19 performed a randomised, double-blind placebocontrolled trial with 36 adults and adolescents treating them with swallowed budesonide for 15 days. On followup oesophagogastroduodenoscopy, the oesophageal eosinophilia and furrowing drastically improved, but the corrugated rings persisted. Oesophageal dilation is often necessary to correct this fixed stenosis, which relieves the solid food dysphagia and alleviates the fear of food impaction, improving quality of life. Potential side effects of too aggressive dilation are concerning, but the longterm relief seems to outweigh these complications. This systematic narrative review will discuss the pathophysiology producing remodelling and strictures, review the available case series, discuss the technique of oesophageal dilation in the management of adult EoO patients and its potential complications. PathophysiologyOesophageal remodelling in EoO patients is a major factor contributing to the clinical complaint of solid food dysphagia. The process begins with an influx of inflammatory cells, especially eosinophils into the mucosa of the oesophagus. Over time, numerous microscopic changes occur including basal cell hyperplasia, elongated rete pegs, smooth muscle hypertrophy ⁄ hyperplasia, and lamina propria ⁄ subepithelial fibrosis. 20 These histopathologic changes are evident on endoscopy as strictures, narrowing and rings and on endoscopic ultrasound as diffuse thickening of all layers of the oesophagus. 21 Most of what we know about the remodelling process in EoO is based u...

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Prevalence of esophageal dysmotility in a cohort of patients with esophageal biopsies consistent with eosinophilic esophagitis

Cited by 36 publications

References 28 publications

Mechanical Properties of the Esophagus in Eosinophilic Esophagitis

Mechanical Properties of the Esophagus in Eosinophilic Esophagitis

Esophageal Motor Disorders in Adults with Eosinophilic Esophagitis

Review article: oesophageal dilation in adults with eosinophilic oesophagitis

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