Esophageal Dysmotility Is Associated With Disease Severity in Eosinophilic Esophagitis.
Achalasia
Dysphagia
Esophageal Spasm
Impedance
Manometry
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
received:
14
09
2021
revised:
26
10
2021
accepted:
01
11
2021
pubmed:
13
11
2021
medline:
28
7
2022
entrez:
12
11
2021
Statut:
ppublish
Résumé
An association of eosinophilic esophagitis (EoE) with esophageal dysmotility has been described, however, the related mechanism remains unclear. We aimed to evaluate clinical and physiologic characteristics, including esophageal distensibility, associated with secondary peristalsis in patients with EoE. A total of 199 consecutive adult patients with EoE (age, 18-78 y; 32% female) who completed a 16-cm functional luminal imaging probe (FLIP) during endoscopy were evaluated in a cross-sectional study. FLIP panometry contractile response (CR) patterns were classified as normal CR or borderline CR if antegrade contractions were present, and abnormal CRs included impaired/disordered CR, absent CR, or spastic-reactive CR. The distensibility plateau of the esophageal body and esophagogastric junction distensibility was measured with FLIP. FLIP CR patterns included 68 (34%) normal CR, 65 (33%) borderline CR, 44 (22%) impaired/disordered CR, 16 (8%) absent CR, and 6 (3%) spastic-reactive CR. Compared with normal CRs, abnormal CRs more frequently had reduced esophageal distensibility (distensibility plateau <17 mm in 56% vs 32%), greater total EoE reference scores (median, 5; interquartile range [IQR], 3-6 vs median, 4; IQR, 3-5) with more severe ring scores, and a greater duration of symptoms (median, 10 y; IQR, 4-23 y vs median, 7 y; IQR, 3-15 y). Mucosal eosinophil density, however, was similar between abnormal CRs and normal CRs (median, 34 eosinophils/high-power field [hpf]; IQR, 14-60 eosinophils/hpf vs median, 25 eosinophils/hpf; IQR, 5-50 eosinophils/hpf). Although normal secondary peristalsis was observed frequently in this EoE cohort, abnormal esophageal CRs were related to EoE disease severity, especially features of fibrostenosis. This study evaluating secondary peristalsis in EoE suggests that esophageal wall remodeling, rather than eosinophilic inflammatory intensity, was associated with esophageal dysmotility in EoE.
Sections du résumé
BACKGROUND & AIMS
An association of eosinophilic esophagitis (EoE) with esophageal dysmotility has been described, however, the related mechanism remains unclear. We aimed to evaluate clinical and physiologic characteristics, including esophageal distensibility, associated with secondary peristalsis in patients with EoE.
METHODS
A total of 199 consecutive adult patients with EoE (age, 18-78 y; 32% female) who completed a 16-cm functional luminal imaging probe (FLIP) during endoscopy were evaluated in a cross-sectional study. FLIP panometry contractile response (CR) patterns were classified as normal CR or borderline CR if antegrade contractions were present, and abnormal CRs included impaired/disordered CR, absent CR, or spastic-reactive CR. The distensibility plateau of the esophageal body and esophagogastric junction distensibility was measured with FLIP.
RESULTS
FLIP CR patterns included 68 (34%) normal CR, 65 (33%) borderline CR, 44 (22%) impaired/disordered CR, 16 (8%) absent CR, and 6 (3%) spastic-reactive CR. Compared with normal CRs, abnormal CRs more frequently had reduced esophageal distensibility (distensibility plateau <17 mm in 56% vs 32%), greater total EoE reference scores (median, 5; interquartile range [IQR], 3-6 vs median, 4; IQR, 3-5) with more severe ring scores, and a greater duration of symptoms (median, 10 y; IQR, 4-23 y vs median, 7 y; IQR, 3-15 y). Mucosal eosinophil density, however, was similar between abnormal CRs and normal CRs (median, 34 eosinophils/high-power field [hpf]; IQR, 14-60 eosinophils/hpf vs median, 25 eosinophils/hpf; IQR, 5-50 eosinophils/hpf).
CONCLUSIONS
Although normal secondary peristalsis was observed frequently in this EoE cohort, abnormal esophageal CRs were related to EoE disease severity, especially features of fibrostenosis. This study evaluating secondary peristalsis in EoE suggests that esophageal wall remodeling, rather than eosinophilic inflammatory intensity, was associated with esophageal dysmotility in EoE.
Identifiants
pubmed: 34768010
pii: S1542-3565(21)01181-2
doi: 10.1016/j.cgh.2021.11.002
pmc: PMC9081296
mid: NIHMS1784684
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1719-1728.e3Subventions
Organisme : NIDDK NIH HHS
ID : P01 DK117824
Pays : United States
Informations de copyright
Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.
Références
Dis Esophagus. 2016 Feb-Mar;29(2):174-8
pubmed: 25626069
Neurogastroenterol Motil. 2016 Dec;28(12):1854-1860
pubmed: 27380834
Clin Gastroenterol Hepatol. 2021 Aug;19(8):1554-1563
pubmed: 32763482
Neurogastroenterol Motil. 2022 Jan;34(1):e14192
pubmed: 34120383
Neurogastroenterol Motil. 2011 Mar;23(3):208-14, e111
pubmed: 21091849
Gut. 2013 Apr;62(4):489-95
pubmed: 22619364
Am J Gastroenterol. 2018 Nov;113(11):1594-1599
pubmed: 30315308
Dis Esophagus. 2013 Nov-Dec;26(8):766-75
pubmed: 22891632
Am J Gastroenterol. 2016 Dec;111(12):1726-1735
pubmed: 27725650
Dig Liver Dis. 2011 Feb;43(2):116-20
pubmed: 20943447
Clin Gastroenterol Hepatol. 2013 Sep;11(9):1101-1107.e1
pubmed: 23591279
Neurogastroenterol Motil. 2021 May;33(5):e14055
pubmed: 33280206
Neurogastroenterol Motil. 2017 Mar;29(3):
pubmed: 27699951
Gastroenterology. 2013 Dec;145(6):1230-6.e1-2
pubmed: 23954315
Gut. 1994 Nov;35(11):1523-8
pubmed: 7828966
Am J Surg Pathol. 1994 Apr;18(4):327-37
pubmed: 8141427
Obes Surg. 2009 Jul;19(7):905-14
pubmed: 19424766
Neurogastroenterol Motil. 2021 Jan;33(1):e14058
pubmed: 33373111
Clin Gastroenterol Hepatol. 2019 Mar;17(4):674-681.e1
pubmed: 30081222
Neurogastroenterol Motil. 2021 Oct;33(10):e14116
pubmed: 33705590
Gastroenterology. 2018 Oct;155(4):1022-1033.e10
pubmed: 30009819
Aliment Pharmacol Ther. 2010 Mar;31(5):601-6
pubmed: 20003176
Neurogastroenterol Motil. 2016 Jan;28(1):139-45
pubmed: 26542087
Surgery. 1986 Aug;100(2):430-6
pubmed: 3738763