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Esophageal distensibility indicative of eosinophilic esophagitis severity
Patients with eosinophilic esophagitis who had reduced esophageal distensibility were more likely to experience food impaction and require esophageal dilation in a recent study.
Researchers performed endoscopy, esophageal biopsy and impedance planimetry via a functional lumen-imaging probe (FLIP) in 70 patients with eosinophilic esophagitis (EE) at the Esophageal Center of Northwestern University in Chicago between July 2009 and May 2012. Follow-up was performed after 12 months, or earlier in the event that immediate intervention was required (mean 9.2 months).
All participants received proton-pump inhibitor therapy prior to FLIP, and the cohort included 21 patients with PPI-responsive EE (PPI-R-EE). Food impaction occurred during follow-up in 12 cases, with emergent endoscopy required in seven patients. Dilation was performed in 25 patients, including 18 who also required changes to medical therapy.
Distensibility plateau (DP) as indicated by FLIP was significantly correlated with ring score (r=-0.52, P<.001), but not with mean eosinophil density (r=-0.1, P=.42). Investigators also noted that patients with ring scores of grade 1 or 2 who presented with food impaction had significantly lower DP compared to those who did not (P<.001 for grade 1 and P<.05 for grade 2).
Patients who experienced impaction during follow-up had significantly lower DP than those who did not. Distensibility metrics were lower among patients who had previously experienced food impaction than in those with solid food dysphagia alone, but eosinophil density was similar between these patient groups. Similarly, distensibility metrics were also significantly lower among patients who required dilation after food impaction during follow-up compared to those who did not receive dilation, while eosinophil density did not differ. No correlations were observed between impaction, DP or dilation requirement and mucosal eosinophilia severity.
After adjusting for confounders, DP was significantly associated with a history of impaction (adjusted OR=0.37, 0.23-0.59 per 10-mm2 change), experiencing impaction during follow-up (aOR=0.73, 0.56-0.96) and need for dilation (aOR=0.78, 0.63-0.96).
“EoE is primarily a mechanical disease, and esophageal distensibility is an important biomarker of disease activity and risk of food impaction,” researcher John E. Pandolfino, MD, department of medicine at Northwestern University Feinberg School of Medicine, told Healio.com. “Risk for food impaction can be lowered significantly if the minimal esophageal diameter can be targeted to 17 mm or above.”
Disclosure: The researchers report no relevant financial disclosures.