Motility Disorders Can Exist in Patients With Eosinophilic Esophagitis, Specifically in Those Not Responding to Therapy
Prateek Sharma, MD, FASGE, reviewing Ghisa M, et al. Clin Gastroenterol Hepatol 2020 Aug 4.
Eosinophilic esophagitis (EoE) is characterized by the presence of esophageal dysfunction along with histological evidence of ≥15 eosinophils per high-power field from esophageal biopsies. Recent studies have demonstrated eosinophilic infiltration of the esophageal wall in motility disorders like achalasia, although its role is not clear. The possibility of overlapping conditions like EoE and motility disorders has been entertained by several investigators.
A total of 109 patients (mean age, 37 years; 82 males) who had a new diagnosis of EoE (by upper endoscopy and biopsy) and underwent a high-resolution manometry (HRM) were included in the study. Of the 109 patients, 68 (62%) had a normal HRM, 24 (22%) had minor motor disorders, and 17 (16%) had major motor disorders (per Chicago classification). Eight patients (7.3%) had achalasia, and 8 (7.3%) had non-achalasia obstructive disorders. The group of patients with EoE and major motor disorders had more females (19 vs 8; P=.011) and responded less to topical steroids (8/16 vs 52/55; P=.005) compared to the group of patients with EoE and no motility problems. There was also a delay in diagnosis noted in the patients with EoE and achalasia (6 years) compared to the patients with EoE and without achalasia obstruction (1.5 years; P=.038).
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Ghisa M, Laserra G, Marabotto E, et al. Achalasia and obstructive motor disorders are not uncommon in patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2020 Aug 4. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.07.056)