Association between eosinophilic esophagitis and esophageal dysmotility: A systematic review and meta‐analysis

Abstract

Background: There is conflicting evidence about the association between eosinophilic esophagitis (EoE) and esophageal motility disorders. The aim of this study was to evaluate esophageal manometry findings in EoE. Methods:We conducted a systematic review using PubMed, EMBASE, and Web of Science. All articles from 1990 to 2021 with EoE patients who underwent esophageal manometry were eligible. We also included pertinent abstracts from national conferences from 2015 to 2020. The primary outcomes were the prevalence of specific Chicago 3 Classification (CCv3) diagnoses in EoE, as well as broader categories of non-relaxing lower esophageal sphincter, and major and minor peristaltic disorders.When multiple studies reported a specific outcome, we performed random effects meta-analysis to obtain pooled prevalence of each outcome. To reduce heterogeneity, we restricted meta-analysis to high-resolution manometry (HRM) studies only.Key Results: Of 763 publications identified, 27 original studies met criteria for inclusion, encompassing 706 EoE patients; 14 studies (425 patients) had HRM and underwent meta-analysis. The pooled prevalence of any motility abnormality was 53% (95% CI: 43%-63%), largely comprised of minor motility disorders such as ineffective esophageal motility and fragmented peristalsis. Major motility disorders, classified by CCv3, were less common in EoE, with pooled prevalence of 2% (0%-7%), 10% (5%-16%), and 1% (0%-3%), for achalasia, esophagogastric-junction outflow obstruction, and hypercontractile disorders, respectively. Conclusion and Inferences:Non-specific motility disorders were common in patients with EoE, but major motility disorders were rare. Further studies are needed to determine the relationship between eosinophilic infiltration and the clinical relevance of abnormal esophageal motility findings in this population.

Sudden-Onset Back Pain and Intermittent Dyspnea While Eating: A Case of Pediatric Achalasia

“…Interestingly, eosinophilic esophagitis, a condition with a prevalence of approximately 57 per 100,000 persons, has been found to be associated with achalasia [3,[9][10][11]. Eosinophilic esophagitis is an allergic/immune-mediated disease that involves the eosinophilic infiltration of the esophageal mucosa.…”

Neuroimmune interplay during type 2 inflammation: Symptoms, mechanisms, and therapeutic targets in atopic diseases

“… 70 , 195 , 197 However, some experts suggest that dysphagia is mostly related to tissue remodeling. 198 – 200 …”

The last step to achieve barrier damage control

“…A dysregulated neural control of the esophagus is present and directly related to dysphagia in these patients. Nociceptive sensitization within the esophageal mucosa, resulting from inflammation, leads to motor pain, dysfunction and possibly tissue remodelling as in other respiratory and skin diseases, remodelling is mainly inflammation-driven in EoE ( 30 , 31 ).…”