Esophageal Dysmotility Is Associated With Disease Severity in Eosinophilic Esophagitis

Carlson, Dustin A.; Shehata, Christina; Gonsalves, Nirmala; Hirano, Ikuo; Peterson, Stephanie; Prescott, Jacqueline; Farina, Domenico; Schauer, Jacob M.; Kou, Wenjun; Kahrilas, Peter J.; Pandolfino, John E.

doi:10.1016/j.cgh.2021.11.002

Cited by 33 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The resolution of esophageal pressurizations following treatment presumably reflects an increase in esophageal wall compliance rather than a change is esophageal motility. Accordingly, a study investigating esophageal secondary peristalsis during FLIP (functional luminal imaging probe) panometry found that patients with abnormal contractile responses had greater esophageal remodeling and similar esophageal eosinophil density compared to those with normal contractile responses, suggesting that decreased distensibility of the esophageal body and EGJ could be more relevant than eosinophil inflammatory intensity in the context of abnormal secondary peristalsis [ 63 ]. However, motor abnormalities may require invasive management for symptoms resolution in selected cases.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review: esophageal motility patterns in patients with eosinophilic esophagitis

Visaggi

Ghisa

Barberio

et al. 2022

Digestive and Liver Disease

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Systematic Review: esophageal motility patterns in patients with eosinophilic esophagitis

Visaggi

Ghisa

Barberio

et al. 2022

Digestive and Liver Disease

View full text Add to dashboard Cite

“…In one study of 199 patients with EoE, the contractile response pattern was characterized by FLIP, and only 34% of EoE patients had a normal contractile response with the remaining patients having abnormal contractile response patterns. An abnormal contractile response was associated with fibrostenotic disease, but there was no difference in levels of eosinophils on histology among the different response patterns [27 ▪ ]. Oesophageal hypervigilance and symptom-specific anxiety may contribute to ongoing symptoms in EoE patients.…”

Section: What Are the Reasons For Nonresponse?mentioning

confidence: 85%

Refractory eosinophilic esophagitis: what to do when the patient has not responded to proton pump inhibitors, steroids and diet

Strauss

Falk

2022

Current Opinion in Gastroenterology

View full text Add to dashboard Cite

Purpose of reviewManagement for patients with refractory eosinophilic esophagitis (EoE) remains a clinical challenge. This review aims to define refractory EoE, explore rates and reasons for nonresponse, and discuss the evidence that informs the approach to these patients.Recent findingsMany patients will fail first-line therapies for EoE. Longer duration of therapy can increase response rates, and initial nonresponders may respond to alternative first-line therapies. There are ongoing clinical trials evaluating novel therapeutics that hold promise for the future of EoE management. Increasingly, there is recognition of the contribution of oesophageal hypervigilance, symptom-specific anxiety, abnormal motility and oesophageal remodelling to ongoing clinical symptoms in patients with EoE.SummaryFor refractory EoE, clinicians should first assess for adherence to treatment, adequate dosing and correct administration. Extending initial trials of therapy or switching to an alternative first-line therapy can increase rates of remission. Patients who are refractory to first-line therapy can consider elemental diets, combination therapy or clinical trials of new therapeutic agents. Patients with histologic remission but ongoing symptoms should be evaluated for fibrostenotic disease with EGD, barium esophagram or the functional luminal imaging probe (FLIP) and should be assessed for the possibility of oesophageal hypervigilance.

show abstract

“…5 Esophageal physiologic testing may play a role in clarifying the competing theories. For example, amongst the measures of HRM, intrabolus pressure (IBP) could potentially be used to differentiate between fibrostenotic and inflammatory patterns in patients with EoE, as seen in Colizzo et al 29 Carlson et al 48 Many studies reported improvement in symptoms or histology with steroid treatment, but only a few performed manometry after steroid treatment to evaluate the manometric correlates of effective treatment. One case report 49 showed subsequent improvement in manometric values recorded after corticosteroid therapy, suggesting resolution of the dysmotility.…”

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

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.

show abstract

Esophageal Dysmotility Is Associated With Disease Severity in Eosinophilic Esophagitis

Cited by 33 publications

References 23 publications

Systematic Review: esophageal motility patterns in patients with eosinophilic esophagitis

Systematic Review: esophageal motility patterns in patients with eosinophilic esophagitis

Refractory eosinophilic esophagitis: what to do when the patient has not responded to proton pump inhibitors, steroids and diet

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

Contact Info

Product

Resources

About