TY - JOUR
T1 - Esophageal Dysmotility Is Associated With Disease Severity in Eosinophilic Esophagitis
AU - Carlson, Dustin A.
AU - Shehata, Christina
AU - Gonsalves, Nirmala
AU - Hirano, Ikuo
AU - Peterson, Stephanie
AU - Prescott, Jacqueline
AU - Farina, Domenico A.
AU - Schauer, Jacob M.
AU - Kou, Wenjun
AU - Kahrilas, Peter J.
AU - Pandolfino, John E.
N1 - Funding Information:
Funding This work was supported by Public Health service grant P01 DK117824 (J.E.P.) and an American College of Gastroenterology Junior Faculty Development Award (D.A.C.).
Funding Information:
Funding This work was supported by Public Health service grant P01 DK117824 (J.E.P.) and an American College of Gastroenterology Junior Faculty Development Award (D.A.C.). Conflicts of interest These authors disclose the following: John E. Pandolfino and Peter J. Kahrilas (with Northwestern University) hold shared intellectual property rights and ownership surrounding FLIP panometry systems, methods, and apparatus with Medtronic, Inc; Dustin A. Carlson is a speaker for Medtronic, and a consultant for Medtronic and Phathom Pharmaceuticals; Nirmala Gonsalves consults for Allakos, Astra-Zenca, AbbVie, Sanofi-Regeneron, Nutricia, and Knopp Pharma, and is on the speakers bureau for Takeda; Ikuo Hirano has consulted for Adare/Ellodi, Allakos, AstraZeneca, Celgene/Receptos/Bristol Meyers Squibb, Sanofi/Regeneron, Shire/Takeda, Amgen Arena, Eli Lilly, EsoCap, Gossamer Bio, and Parexel/Calyx, has provided clinical trial support for Adare/Ellodi, Allakos, AstraZeneca, Celgene/Receptos/Bristol Meyers Squibb, Sanofi/Regeneron, Shire/Takeda, and Arena, and has been a speaker for Sanofi/Regeneron and Shire/Takeda; Peter J. Kahrilas has consulted for Ironwood, Reckitt Benckiser, and Johnson & Johnson; and John E. Pandolfino has consulted for Sandhill Scientific/Diversatek, Medtronic, Torax, and Ironwood, has been a speaker for Sandhill Scientific/Diversatek, Takeda, Astra Zeneca, Medtronic, and Torax, has received grant support from Sandhill Scientific/Diversatek, and owns a patent and license with Medtronic. The remaining authors disclose no conflicts.
Publisher Copyright:
© 2022 AGA Institute
PY - 2022/8
Y1 - 2022/8
N2 - 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.
AB - 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.
KW - Achalasia
KW - Dysphagia
KW - Esophageal Spasm
KW - Impedance
KW - Manometry
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U2 - 10.1016/j.cgh.2021.11.002
DO - 10.1016/j.cgh.2021.11.002
M3 - Article
C2 - 34768010
AN - SCOPUS:85120967445
VL - 20
SP - 1719-1728.e3
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
IS - 8
ER -