Esophageal dysmotility in patients who have eosinophilic esophagitis

Abstract

The understanding of esophageal motility alterations in patients who have eosinophilic esophagitis (EE) is in its infancy despite the common presenting complaint of dysphagia. A diversity of motility disorders has been reported in patients who have EE including achalasia, diffuse esophageal spasm, nutcracker esophagus, and nonspecific motility alterations including high-amplitude esophageal body contractions, tertiary contractions, abnormalities in lower esophageal sphincter pressure, and other peristaltic problems. Some evidence suggests that treatment of EE will improve motility. Technological advances such as high-resolution manometry and combined manometry with impedance may provide new insight into more subtle motility abnormalities.

Figure 1

Normal esophageal peristalsis with good esophageal clearance as evidenced by a drop in impedance followed by a subsequent return to baseline in all of the impedance channels.

Figure 2

A high amplitude contraction in the distal esophagus with normal esophageal clearance as evidenced by drop in impedance followed by a subsequent return to baseline in all of the impedance channels.

Figure 3

Simultaneous, non-peristaltic esophageal contractions with no impedance changes in the esophagus indicating poor esophageal clearance.

Figure 4

Tracing from a 24 hour manometry showing absent mid-esophageal peristalsis with a simultaneous symptom of dysphagia.

Figure 5

Tracing from a 24 hour manometry showing high amplitude distal contractions.