Background & Aims

An association of eosinophilic esophagitis (EoE) with esophageal dysmotility has been described, however, the related mechanism remains unclear. We aimed to evaluate clinical and physiologic characteristics, including esophageal distensibility, associated with secondary peristalsis in patients with EoE.

Methods

A total of 199 consecutive adult patients with EoE (age, 18–78 y; 32% female) who completed a 16-cm functional luminal imaging probe (FLIP) during endoscopy were evaluated in a cross-sectional study. FLIP panometry contractile response (CR) patterns were classified as normal CR or borderline CR if antegrade contractions were present, and abnormal CRs included impaired/disordered CR, absent CR, or spastic-reactive CR. The distensibility plateau of the esophageal body and esophagogastric junction distensibility was measured with FLIP.

Results

FLIP CR patterns included 68 (34%) normal CR, 65 (33%) borderline CR, 44 (22%) impaired/disordered CR, 16 (8%) absent CR, and 6 (3%) spastic-reactive CR. Compared with normal CRs, abnormal CRs more frequently had reduced esophageal distensibility (distensibility plateau <17 mm in 56% vs 32%), greater total EoE reference scores (median, 5; interquartile range [IQR], 3–6 vs median, 4; IQR, 3–5) with more severe ring scores, and a greater duration of symptoms (median, 10 y; IQR, 4–23 y vs median, 7 y; IQR, 3–15 y). Mucosal eosinophil density, however, was similar between abnormal CRs and normal CRs (median, 34 eosinophils/high-power field [hpf]; IQR, 14–60 eosinophils/hpf vs median, 25 eosinophils/hpf; IQR, 5–50 eosinophils/hpf).

Conclusions

Although normal secondary peristalsis was observed frequently in this EoE cohort, abnormal esophageal CRs were related to EoE disease severity, especially features of fibrostenosis. This study evaluating secondary peristalsis in EoE suggests that esophageal wall remodeling, rather than eosinophilic inflammatory intensity, was associated with esophageal dysmotility in EoE.

中文翻译：

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食管运动障碍与嗜酸性粒细胞性食管炎的疾病严重程度相关

背景与目标

嗜酸性粒细胞性食管炎（EoE）与食管运动障碍之间的关联已被描述，但相关机制仍不清楚。我们的目的是评估 EoE 患者的临床和生理特征，包括与继发性蠕动相关的食管扩张性。

方法

一项横断面研究对在内窥镜检查期间完成 16 厘米功能性管腔成像探针 (FLIP) 的连续 199 名 EoE 成年患者（年龄，18-78 岁；32% 女性）进行了评估。如果存在顺行收缩，则 FLIP 全景收缩反应 (CR) 模式被分类为正常 CR 或临界 CR，异常 CR 包括 CR 受损/紊乱、CR 缺失或痉挛反应性 CR。用FLIP测量食管体的扩张平台和食管胃连接部的扩张能力。

结果

FLIP CR 模式包括 68 例 (34%) 正常 CR、65 例 (33%) 临界 CR、44 例 (22%) 受损/紊乱 CR、16 例 (8%) 缺失 CR 和 6 例 (3%) 痉挛反应性 CR。与正常 CR 相比，异常 CR 更常出现食管扩张性降低（扩张平台 <17 毫米，分别为 56% 和 32%）、较高的总 EoE 参考分数（中位数为 5；四分位距 [IQR]，3-6 与中位数为 4） ；IQR，3-5），环评分更严重，症状持续时间更长（中位数，10 年；IQR，4-23 年 vs 中位数，7 年；IQR，3-15 年）。然而，异常 CR 和正常 CR 之间的粘膜嗜酸性粒细胞密度相似（中位数，34 个嗜酸性粒细胞/高倍视野 [hpf]；IQR，14-60 个嗜酸性粒细胞/hpf vs 中位数，25 个嗜酸性粒细胞/hpf；IQR，5-50 个嗜酸性粒细胞/hpf）。

结论

尽管在此 EoE 队列中经常观察到正常的二次蠕动，但异常的食管 CR 与 EoE 疾病的严重程度相关，尤其是纤维狭窄的特征。这项评估 EoE 继发蠕动的研究表明，食管壁重塑（而不是嗜酸性粒细胞炎症强度）与 EoE 食管运动障碍相关。