Clinical relevance of esophageal subepithelial activity in eosinophilic esophagitis

Ikuo Hirano*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Esophageal subepithelial activity (ESEA) is an important determinant of disease severity and complications in eosinophilic esophagitis (EoE). Inflammation and fibrosis of the lamina propria and muscularis propria result in esophageal dysfunction and stricture formation that are clinically manifest by symptoms of dysphagia and food impaction as well as the need for esophageal dilation. Esophageal biopsies that are limited to the evaluation of the esophageal epithelium are an inadequate means to assess overall, clinical disease severity in EoE. Instruments for the assessment of subepithelial activity in EoE are both limited and/or underutilized and thus represent an important unmet clinical need. Studies using endoscopic features, endoscopic ultrasonography, and barium esophagography have demonstrated improvement in ESEA parameters with topical steroid therapy. Impedance planimetry is being evaluated as an objective and quantifiable measure of esophageal distensibility that is a consequence of ESEA. In conjunction with symptom and histologic assessment, evaluation of ESEA provides a more complete evaluation of disease activity in EoE that will enhance clinical care as well as provide insights into the strengths and limitations of therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)249-260
Number of pages12
JournalJournal of Gastroenterology
Volume55
Issue number3
DOIs
StatePublished - Mar 1 2020

Keywords

  • Dysphagia
  • Eosinophilic esophagitis
  • Eosinophilic gastrointestinal disease
  • Esophageal stricture

ASJC Scopus subject areas

  • Gastroenterology

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