Improvement in Esophageal Distensibility in Response to Medical and Diet Therapy in Eosinophilic Esophagitis

Dustin A. Carlson*, Ikuo Hirano, Angelika Zalewski, Nirmala Gonsalves, Zhiyue Lin, John E. Pandolfino

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Objectives:We aimed to evaluate the effect of medical and diet therapies on esophageal distensibility assessed using the functional lumen imaging probe (FLIP) and the association of changes in esophageal distensibility with clinical outcomes in eosinophilic esophagitis (EoE).Methods:Patients with EoE were evaluated with FLIP during endoscopy at baseline and following therapy without interval dilatation. Evaluation also included a validated patient-reported outcome (PRO; a positive PRO was considered at a 30% score improvement), mucosal biopsies, and scoring of endoscopic features of EoE. FLIP data were analyzed to calculate the distensibility plateau (DP).Results:In all, 18 patients (ages 19-54 years; 4 female) treated with topical steroid (8), elimination diet (6), and/or proton-pump inhibitor (4 only treated with proton-pump inhibitor) were included. Follow-up testing occurred at a mean (range) of 14.6 (8-28) weeks. Improvement was observed in DP (13.9 (12.2-19.2) to 16.8 mm (15.8-19.2), P=0.007) and peak eosinophil count (45 (29-65) to 23 per high-power field (h.p.f.) (5-53), P=0.042). Nine patients had a positive symptomatic outcome. Six of 8 (75%) patients with a DP increase ≥2 mm had a positive PRO (P=0.077), while 2 of 7 (29%) patients that achieved an eosinophil count <15/h.p.f. had a positive PRO (P=0.167).Conclusions:Improvement in esophageal body distensibility can be achieved with medical and diet therapies without dilation in EoE. Improved DP appeared to be better indicator of symptomatic improvement than eosinophil count, supporting FLIP as a valuable outcome measure in EoE.

Original languageEnglish (US)
Article numbere119
JournalClinical and translational gastroenterology
Volume8
Issue number10
DOIs
StatePublished - Oct 5 2017

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ASJC Scopus subject areas

  • Gastroenterology

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