Esophageal Distensibility as a Measure of Disease Severity in Patients With Eosinophilic Esophagitis

doi:10.1016/j.cgh.2013.03.020

Clinical Gastroenterology and Hepatology

Volume 11, Issue 9, September 2013, Pages 1101-1107.e1

https://doi.org/10.1016/j.cgh.2013.03.020 Get rights and content

Background & Aims

The aim of this study was to assess whether measurements of esophageal distensibility, made by high-resolution impedance planimetry, correlated with important clinical outcomes in patients with eosinophilic esophagitis.

Methods

Seventy patients with eosinophilic esophagitis (50 men; age, 18–68 y) underwent endoscopy with esophageal biopsy collection and high-resolution impedance planimetry using the functional lumen-imaging probe. The patients were followed up prospectively for an average of 9.2 months (range, 3–14 mo), and the risk of food impaction, requirement for dilation, and symptom severity during the follow-up period was determined from medical records. Esophageal distensibility metrics and the severity of mucosal eosinophilia at baseline were compared between patients presenting with and without food impaction and those requiring or not requiring esophageal dilation. Logistic regression and stratification assessments were used to assess the predictive value of esophageal distensibility metrics in assessing risk of food impaction, the need for dilation, and continued symptoms.

Results

Patients with prior food impactions had significantly lower distensibility plateau (DP) values than those with solid food dysphagia alone. In addition, patients sustaining food impaction and requiring esophageal dilation during the follow-up period had significantly lower DP values than those who did not. The severity of mucosal eosinophilia did not correlate with risk for food impaction, the requirement for dilation during follow-up evaluation, or DP values.

Conclusions

Reduced esophageal distensibility predicts risk for food impaction and the requirement for esophageal dilation in patients with eosinophilic esophagitis. The severity of mucosal eosinophilia was not predictive of these outcomes and had a poor correlation with esophageal distensibility.

Section snippets

Subjects

Seventy-seven patients (55 men; age, 18–68 y), who presented to the Esophageal Center at Northwestern from July 2009 to May 2012 with food impaction, dysphagia, chest pain, or heartburn, and histology reporting 15 or more eosinophils/hpf (magnification, 0.196 mm²),¹⁰ were enrolled to assess the biomechanical properties of the esophageal wall.⁹ After a trial of PPI therapy, a second endoscopy with repeated biopsies and high-resolution impedance planimetry using the FLIP device was performed to

Baseline Clinical Data

Seventy patients were included for analysis (4 patients had technically limited studies and 3 subjects were lost to follow-up evaluation). Baseline characteristics are shown in Table 1. All patients had a trial of PPI therapy before the FLIP was performed. At the time of the second endoscopy with the FLIP procedure, 21 patients were noted to have fewer than 15 eosinophils/hpf in both the proximal and distal biopsy locations and they were classified as PPI-R-EE. The remaining 49 patients fit the

Discussion

This study assessed whether measurements of esophageal distensibility with the FLIP during endoscopy correlated with clinically relevant outcomes in EoE patients. The major findings were that reduced esophageal distensibility (DP < 225 mm²) was associated with an increased risk of food impaction and requirement of esophageal dilation during a 4- to 12-month follow-up period. In addition, there was a relationship between DP and symptom score during follow-up evaluation suggesting that this

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Endoscopic Features of Eosinophilic Gastrointestinal Diseases
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Composite score of physiomechanical esophageal function using functional lumen imaging probe panometry in eosinophilic esophagitis
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The evaluation provided by functional lumen imaging probe (FLIP) panometry includes esophageal distensibility/compliance (mechanics) of the esophageal body and esophagogastric junction (EGJ) and esophageal motility (secondary peristalsis). We developed a composite score using these parameters to characterize physiomechanical function in patients with eosinophilic esophagitis (EoE).
Two hundred fifteen adult patients with EoE who completed FLIP panometry during sedated endoscopy with esophageal biopsy sampling were included. FLIP metrics of esophageal body Compliance, Contractile response, Distensibility plateau, and maximum EGJ Diameter (C2D2) were scored as 0 for normal versus 1 or 2 for increasing degree of abnormality. Scores were summed to calculate the composite C2D2 score.
The C2D2 score had a significant positive correlation with mucosal eosinophil count (ρ = .241) and total Endoscopic EoE Reference Score (ρ = .467). Among 46 patients off treatment at the baseline evaluation, future proton pump inhibitor (PPI) responders (ie, achieved mucosal eosinophil count <15 per high-powered field after PPI treatment) had lower C2D2 scores than PPI nonresponders (median, 2 [interquartile range, 1-3] vs 4 [interquartile range, 2-6], respectively; P = .003). A regression model (that controlled for age, sex, and baseline eosinophil count) showed a C2D2 score ≤3 had an odds ratio of 14.5 (95% confidence interval, 2.6-85) to predict future PPI response. However, total Endoscopic EoE Reference Scores (P = .142) and baseline eosinophil count (P = .480) did not differ between PPI responders and PPI nonresponders.
This composite score of FLIP panometry metrics, the C2D2 score, may facilitate characterizing physiomechanical function in EoE and serve as an objective outcome measure.
Flipping the Script: Diagnostic Delay, Distensibility, and EoE Progression
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The Severity of Reduced Esophageal Distensibility Parallels Eosinophilic Esophagitis Disease Duration
2024, Clinical Gastroenterology and Hepatology
Chronic inflammation of eosinophilic esophagitis (EoE) results in progressive, fibrostenotic remodeling of the esophageal wall. This study aimed to demonstrate objective changes in esophageal distensibility relative to duration of EoE disease using a functional lumen imaging probe (FLIP).
Adult patients with EoE who completed a 16-cm FLIP protocol during endoscopy were evaluated in a cross-sectional study. FLIP analysis focused on distensibility plateau (DP) of the esophageal body. The time from onset of symptoms to time of endoscopy with FLIP was assessed, as was time from symptom onset to EoE diagnosis (ie, diagnostic delay).
A total of 171 patients (mean age 38 ± 12 years; 31% female) were included; the median symptom duration was 8 (interquartile range, 3–15) years and diagnostic delay was 4 (interquartile range, 1–12) years. At the time of endoscopy with FLIP, there were 54 patients (39%) in histologic remission (<15 eosinophils per high-power field [eos/hpf]). Symptom duration and diagnostic delay were negatively correlated with DP (rho = –0.326 and –0.309; P values < .001). Abnormal esophageal distensibility (DP ≤17 mm) was more prevalent with increased duration of symptoms (P < .004): 23% at <5 years to 64% at ≥25 years. When stratifying the cohort based on mucosal eosinophil density, patients with ≥15 eos/hpf had significantly lower DP with greater symptom duration (P = .004), while there was not a significant difference among patients with <15 eos/hpf (P = .060).
Esophageal distensibility objectively measured with FLIP was reduced in EoE patients with greater symptom duration and diagnostic delay. This supports that EoE is a progressive, fibrostenotic disease and that FLIP may be a useful tool to monitor disease progression in EoE.
Functional luminal imaging probe assessment of eosinophilic esophagitis stricture followed by optical-haptic dilation with a dilating cap
2024, VideoGIE

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: Conflicts of interest The authors disclose no conflicts.

: Funding Supported by R01 DK079902 (J.E.P.) and R01 DK56033 (P.J.K.) from the National Institutes of Health.

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Original articleAlimentary tractEsophageal Distensibility as a Measure of Disease Severity in Patients With Eosinophilic Esophagitis

Background & Aims

Methods

Results

Conclusions

Section snippets

Subjects

Baseline Clinical Data

Discussion

Gastroenterology

Immunol Allergy Clin North Am

Gastroenterology

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

J Gastrointest Surg

Gastroenterology

Clin Imaging

Original article
Alimentary tract
Esophageal Distensibility as a Measure of Disease Severity in Patients With Eosinophilic Esophagitis