Background: Esophageal motility, as measured by manometry, is normal in the majority of patients with eosinophilic esophagitis (EoE). However, manometry measures only the circular muscle function of esophagus. The goal of our study was to assess circular and longitudinal muscle function during peristalsis in the EoE patients.
Methods: Ultrasound imaging and manometry were simultaneously acquired during swallow-induced peristalsis in patients with EoE and controls to measure the longitudinal muscle and circular muscle contraction respectively . A Probe with ultrasound transducer was positioned 2 cm and then 10 cm above the lower oesophageal sphincter and five, 5 ml water swallows were recorded before (B) and after edrophonium (ED).
Result: There is no difference in the incidence of swallow-induced peristalsis and manometric pressures (a marker of circular muscle contraction) between controls and EoE patients. However, changes in the muscle thickness (a marker of longitudinal muscle contraction) are markedly diminished in the EoE patients, both at 2 and 10 cm above the lower esophageal sphincter. The longitudinal muscle response to edrophonium is markedly blunted in the EoE patients. Normal subjects demonstrate synchrony between the circular and longitudinal muscle contraction during peristalsis that is affected by edrophonium. On the other hand, EoE patients demonstrate mild asynchrony of circular and longitudinal muscle contraction during swallow-induced contractions that is not altered by edrophonium.
Conclusion: In patients with EoE, there is selective dysfunction of the longitudinal muscle contraction during peristalsis. We propose that the longitudinal muscle dysfunction in the EoE may contribute to dysphagia.