Pediatric Eosinophilic Esophagitis is Associated With Low Baseline Impedance

Abstract

Background and Aims:Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder that requires repeat endoscopic evaluation(s) to assess response to treatment. This results in high health care costs and a procedural burden in affected children. Noninvasive alternate modalities to reassess disease activity have not been established. Low baseline impedance measured by multichannel pH impedance (pH-MII) is seen in adults with EoE, in keeping with poor mucosal integrity. We aimed to investigate the relationship between esophageal eosinophilia (or severity of eosinophilic infiltration) and baseline impedance in children with EoE.Methods:We retrospectively identified 15 children diagnosed with EoE at our institution who had undergone pH-MII within 30 days of 3-level esophageal biopsy. This group were not concurrently prescribed proton pump inhibitors and had negligible reflux parameters on pH-MII. Average impedance baseline was calculated upper, mid, and lower esophageal segments via baseline impedance automated analysis (RIAA) and mean nocturnal baseline impedance (MNBI) methods. Eosinophil count data for upper, mid, and lower esophageal segments in the EoE group was collated.Results:A significantly lower baseline impedance was seen across the esophageal length in children with EoE, compared with 30 controls who had no differences in age or reflux burden on nonparametric testing. A relationship between baseline impedance and eosinophil number at corresponding esophageal segments was not established.Conclusions:Baseline impedance may be an important, less invasive adjunct in clinical practice to monitor treatment response in children with EoE. Larger prospective cohort studies should delineate optimally predictive baseline impedance thresholds for active and inactive disease.

The utility of balloon‐based and standard impedance technology to diagnose esophageal mucosal diseases in children

“…While the value of endoscopic impedance measurements may not add significant value at this time because pediatric gastroenterologists routinely take biopsies during endoscopies to make a mucosal diagnosis, their role may be as an alternative to endoscopy. Studies have shown that measuring nocturnal baseline impedance values during a 24‐h study, for example, may predict which patients have esophagitis 7–9 . Our study suggests that even placement of a probe for much shorter times could give impedance readings that could suggest the presence or absence of esophagitis and its distribution in the esophagus.…”

“…Studies have shown that measuring nocturnal baseline impedance values during a 24-h study, for example, may predict which patients have esophagitis. [7][8][9] Our study suggests that even placement of a probe for much shorter times could give impedance readings that could suggest the presence or absence of esophagitis and its distribution in the esophagus.…”

Trends in gastroesophageal reflux disease research: A bibliometric and visualized study

“…Overall, mucosal impedance, measured with a variety of techniques, either ambulatory setting or single-channel and balloon-based, appears promising and may be able to differentiate GERD from EoE as well as track the histologic progression of EoE (151,(155)(156)(157)(158)(159). Currently, however, data regarding mucosal impedance measurements in EoE are limited.…”