Background & Aims

Eosinophilic esophagitis (EoE) is characterized by eosinophilic inflammation, but also heterogeneous presentations involving fibrostenotic esophageal remodeling and esophageal dysmotility. We aimed to define and evaluate phenotypes of EoE using functional lumen imaging probe (FLIP) panometry (ie, a PhysioMechanical classification of EoE).

Methods

Patients with EoE who completed FLIP during endoscopy were included in a cross-sectional study. FLIP studies were analyzed for distensibility plateau and compliance of the esophageal body, maximum esophagogastric junction diameter, and contractile response pattern. These FLIP features were then applied to define PhysioMechanical classifications.

Results

A total of 215 patients with EoE (mean [standard deviation] age 38 [12] years; 31% female) were included. Seven PhysioMechanical classifications were identified that differed by various clinical characteristics, including symptom duration (P < .001) and Endoscopic EoE Reference Scores (EREFS) (P < .001). In particular, patients with “nonreactive fibrostenosis” (n = 14), had greater symptom duration (median [interquartile range] 20 [10–30] years) and more frequently had EREFS grade 2 or 3 ring scores (14 of 14 patients) than patients with a “normal” PhysioMechanical classification (symptom duration: 3 [1–8] years; 4 of 50 [8%] had EREFS grade 2 or 3 rings). In addition, among patients off treatment at cross-sectional evaluation (n = 46), there was a difference between PhysioMechanical classifications in future proton pump inhibitor (PPI) response rates (ie, achieving peak mucosal eosinophil count <15 per high-powered field after PPI treatment); P = .009. PPI response ranged from 87% (13 of 15 patients) with “isolated esophagogastric junction outflow obstruction” to 11% (1 of 9 patients) with “spastic-reactive fibrostenosis.”

Conclusions

Classifying PhysioMechanical esophageal function in EoE based on FLIP panometry features may facilitate defining disease severity and directing management in EoE.

中文翻译：

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嗜酸粒细胞性食管炎食管功能的物理力学模型

背景与目标

嗜酸性粒细胞性食管炎（EoE）的特点是嗜酸性炎症，但也有涉及纤维狭窄食管重塑和食管运动障碍的异质性表现。我们的目的是使用功能性管腔成像探针 (FLIP) 全景测量法（即 EoE 的物理机械分类）来定义和评估 EoE 的表型。

方法

在内窥镜检查期间完成 FLIP 的 EoE 患者被纳入一项横断面研究。FLIP 研究分析了食管体的扩张平台和顺应性、最大食管胃连接部直径和收缩反应模式。然后应用这些 FLIP 特征来定义物理机械分类。

结果

共有 215 名 EoE 患者（平均 [标准差] 年龄 38 [12] 岁；31% 为女性）纳入研究。确定了七种物理机械分类，这些分类因各种临床特征而异，包括症状持续时间 ( P < .001) 和内镜 EoE 参考评分 (EREFS) ( P < .001)。特别是，患有“非反应性纤维狭窄”的患者（n = 14），症状持续时间更长（中位[四分位距] 20 [10-30]年），并且更频繁地具有 EREFS 2 级或 3 级环评分（14 名患者中的 14 名）比具有“正常”物理机械分类的患者（症状持续时间：3 [1-8] 年；50 人中的 4 人 [8%] 具有 EREFS 2 级或 3 级环）。此外，在横断面评估中停止治疗的患者中（n = 46），未来质子泵抑制剂（PPI）反应率的物理机械分类之间存在差异（即，达到每个高倍视野的峰值粘膜嗜酸性粒细胞计数<15） PPI治疗后）；P  = .009。PPI 反应范围从 87%（15 名患者中的 13 名）患有“孤立性食管胃交界处流出道梗阻”到 11%（9 名患者中的 1 名）患有“痉挛反应性纤维狭窄”。

结论

基于 FLIP 全景测量特征对 EoE 中的生理机械食管功能进行分类可能有助于定义 EoE 疾病的严重程度并指导管理。