Eosinophilic Esophagitis and Achalasia: Two Distinct Nosologic Entities or a Possible Etiopathogenic Association?

Schizas, Dimitrios; Syllaios, Athanasios; Vailas, Michail; Sotiropoulou, Maria; Triantafyllou, Tania; Tsapralis, Dimitrios; Papanikolaou, Ioannis S.; Theodorou, Dimitrios

doi:10.1159/000515520

Cited by 6 publications

(3 citation statements)

References 37 publications

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“…Additionally, eosinophilic infiltration can activate the cytokine-mediated pathways which allows these eosinophils, mast cells, and cytokines to cause remodeling and structural changes to the esophagus. 46,47 Improvement of motility abnormalities with treatments that reduce esophageal eosinophilia suggests that eosinophil-derived substances can alter esophageal motility, perhaps by releasing myoactive and neuroactive eosinophil products. 5 Esophageal physiologic testing may play a role in clarifying the competing theories.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal stasis may also lead to an eosinophilic infiltration in achalasia, which could lead to an incorrect diagnosis of EoE. Additionally, eosinophilic infiltration can activate the cytokine‐mediated pathways which allows these eosinophils, mast cells, and cytokines to cause remodeling and structural changes to the esophagus 46,47 . Improvement of motility abnormalities with treatments that reduce esophageal eosinophilia suggests that eosinophil‐derived substances can alter esophageal motility, perhaps by releasing myoactive and neuroactive eosinophil products 5 …”

Section: Discussionmentioning

confidence: 99%

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

Reddy

Ketchem

Dougherty

et al. 2022

Neurogastroenterology Motil

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Reddy

Ketchem

Dougherty

et al. 2022

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“… 13 , 14 Several studies have reported a possible association between achalasia and EoE in some patients, suggesting poorer outcomes in patients with achalasia in whom EoE is also present. 15 , 16 Thus, endoscopic evaluation with multiple esophageal biopsies is recommended for patients with dysphagia to identify possible EoE.…”

Section: Endoscopic Diagnosis Of Achalasiamentioning

confidence: 99%

Role of endoscopy in patients with achalasia

Han

Youn

2023

Clin Endosc

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Achalasia is an esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and peristalsis of the esophageal body. With the increasing prevalence of achalasia, interest in the role of endoscopy in its diagnosis, treatment, and monitoring is also growing. The major diagnostic modalities for achalasia include high-resolution manometry, esophagogastroduodenoscopy, and barium esophagography. Endoscopic assessment is important for early diagnosis to rule out diseases that mimic achalasia symptoms, such as pseudo-achalasia, esophageal cancer, esophageal webs, and eosinophilic esophagitis. The major endoscopic characteristics suggestive of achalasia include a widened esophageal lumen and food residue in the esophagus. Once diagnosed, achalasia can be treated either endoscopically or surgically. The preference for endoscopic treatment is increasing owing to its minimal invasiveness. Botulinum toxins, pneumatic balloon dilation, and peroral endoscopic myotomy (POEM) are important endoscopic treatments. Previous studies have demonstrated excellent treatment outcomes for POEM, with >95% improvement in dysphagia, making POEM the mainstay treatment option for achalasia. Several studies have reported an increased risk of esophageal cancer in patients with achalasia. However, routine endoscopic surveillance remains controversial owing to the lack of sufficient data. Further studies on surveillance methods and duration are warranted to establish concordant guidelines for the endoscopic surveillance of achalasia.

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Manometric findings in children with eosinophilic esophagitis and persistent post‐remission dysphagia

Yogev,

Dorfman,

Mansi

et al. 2024

JPGN rep.

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ObjectivesDysphagia is a frequent symptom of active eosinophilic esophagitis (EoE), but at times it persists despite attaining histologic healing and lack of fibro‐stenotic changes. We aimed to describe the manometric findings in this subset of patients.MethodsA retrospective review of charts between 2013 and 2023 at a tertiary pediatric gastroenterology center, treating roughly 1500 EoE patients per year. We included children with EoE referred to high‐resolution impedance manometry (HRIM) for persistent dysphagia despite histologic healing (i.e., <15 Eos/hpf). Data including initial EoE diagnosis, endoscopy reports, esophageal biopsies, treatment regimens, and HRIM were retrospectively collected.ResultsThe estimated prevalence of post‐remission dysphagia in our cohort was exceedingly rare (<0.05%). Four patients met the eligibility criteria of histologic remission and absence of fibro‐stenotic features on endoscopic evaluation and thus, were included in this case series. Patients achieved remission with steroids, proton‐pump inhibitor, or both within a median time of 5 months from diagnosis. Peak Eosinophil count at remission was ≤5 Eos/hpf in three patients and ≤10 Eos/hpf in one. On HRIM, all four patients had a hypomotile esophagus and abnormal bolus clearance. Lower esophageal sphincter integrated relaxation pressure values were normal in three patients and elevated in one. Two patients were diagnosed with ineffective esophageal motility, one with aperistalsis and one with achalasia type 1.ConclusionsPost‐remission dysphagia is rare in EoE. Esophageal dysmotility with a hypomotile pattern may contribute to the persistent dysphagia in children with EoE. HRIM should be considered in patients with EoE in whom symptoms persist despite histologic remission.

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Eosinophilic Esophagitis and Achalasia: Two Distinct Nosologic Entities or a Possible Etiopathogenic Association?

Cited by 6 publications

References 37 publications

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

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

Role of endoscopy in patients with achalasia

Manometric findings in children with eosinophilic esophagitis and persistent post‐remission dysphagia

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