Patients with eosinophilic esophagitis symptoms may benefit from gastric emptying studies
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Gastric emptying studies may benefit patients with persistent symptoms of eosinophilic esophagitis who do not respond to treatment, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
These studies may enable clinicians to consider delayed gastric emptying and other concomitant diagnoses, Emad Khosh-Hemmat, BS, a clinical research coordinator at the University of California, San Diego, at the time of the study and a current student at Wake Forest University School of Medicine, and colleagues wrote in the study.
The study involved 84 patients aged 2 to 18 years diagnosed with EoE who underwent a clinically indicated nuclear medicine gastric emptying scan due to persistent symptoms or incomplete histologic response to therapy.
Clinicians performed these scans to see if delayed gastric emptying was the cause of chronic symptoms or pathogenic reflux, in turn causing persistent esophageal eosinophilia.
Twenty-eight patients (86% male; average age at EoE diagnosis, 8.4 years) fit criteria for the normal group, which included studies with a half emptying time of less than 60 minutes. The delayed group, which included studies with a half emptying time of longer than 90 minutes, included 25 patients (64% male; average age at EoE diagnosis, 8.1 years). The borderline group — for those studies between 60 and 90 minutes — included 31 patients (55% male; average age at EoE diagnosis, 7.7 years). The average duration of EoE across all groups was 4 years.
Also, the normal group had an average half emptying time of 39 minutes, the delayed group had an average of 126 minutes, and the borderline group average was 74 minutes (P < .0001).
The researchers found significantly higher odds for having abnormal gastric emptying, inclusive of the delayed and borderline groups, among females compared with males (OR = 4.6; 95% CI, 1.4-15), which the researchers called consistent with documented sexual dimorphism for gastric motility.
Females experienced constipation (56%) more commonly than males as well. Constipation also was significantly more common in the delayed vs. normal group (P = .018).
The patients with delayed emptying were slightly taller than those with normal or borderline emptying, although there were no significant differences in BMI or weight between the groups.
Twenty-three patients received erythromycin as a promotility agent, including 16 in the delayed group, five in the borderline group and two in the normal group. Five of these patients reported clear symptomatic improvement.
Eight of these delayed patients and one of the borderline patients had post-treatment upper gastrointestinal endoscopies, with only four showing improved distal eosinophilia.
Overall, the nuclear medicine scans did not reveal any significant differences between the groups regarding esophageal eosinophilia, the researchers wrote. There also were similar rates of gastroesophageal junction erosions in the normal (36%), delayed (28%) and borderline (29%) groups, with the numerally lower incidence in the delayed group suggesting an etiology not based on motility or reflux for these erosions, according to the researchers.
Considering the similar diagnostic ages and durations of EoE between the groups, the researchers suggested that delayed gastric emptying might not be related to disease course, but it could be a cause of persistent symptoms of eosinophilia.
Further studies are needed, the researchers continued, but patient clinical features and symptom persistence could help determine the need for gastric emptying tests.
When patients experience persistent EoE symptoms such as early satiety, bloating and reflux in particular, the researchers wrote, gastric emptying studies should be considered. Children with delayed gastric emptying and concurrent constipation may have a more global dysmotility requiring diagnosis and management, the researchers concluded.