Manometric features of eosinophilic esophagitis in esophageal pressure topography

Abstract

Background: Although most of the patients with eosinophilic esophagitis (EoE) have mucosal and structural changes that could potentially explain their symptoms, it is unclear whether EoE is associated with abnormal esophageal motor function. The aims of this study were to evaluate the esophageal pressure topography (EPT) findings in EoE and to compare them with controls and patients with gastro-esophageal disease (GERD).

Methods: Esophageal pressure topography studies in 48 EoE patients, 48 GERD patients, and 50 controls were compared. The esophageal contractile pattern was described for ten 5-mL swallows for each subject and each swallow was secondarily characterized based on the bolus pressurization pattern: absent, pan-esophageal pressurization, or compartmentalized distal pressurization.

Key results: Thirty-seven percent of EoE patients were classified as having abnormal esophageal motility. The most frequent diagnoses were of weak peristalsis and frequent failed peristalsis. Although motility disorders were more frequent in EoE patients than in controls, the prevalence and type were similar to those observed in GERD patients (P=0.61, chi-square test). Pan-esophageal pressurization was present in 17% of EoE and 2% of GERD patients while compartmentalized pressurization was present in 19% of EoE and 10% of GERD patients. These patterns were not seen in control subjects.

Conclusions & inferences: The prevalence of abnormal esophageal motility in EoE was approximately 37% and was similar in frequency and type to motor patterns observed in GERD. Eosinophilic esophagitis patients were more likely to have abnormal bolus pressurization patterns during swallowing and we hypothesize that this may be a manifestation of reduced esophageal compliance.

Figure 1

Examples of different pressurization patterns at the 25-mmHg isobaric contour in patients with eosinophilic esophagitis. The early pan-esophageal pressurization occurred in the context of normal peristalsis and normal IRP. The compartmentalized distal pressurization occurred in a patient with normal peristalsis and normal mean IRP (9.5 mmHg). For this particular swallow, the IRP is slightly elevated (16.6 mmHg).

Figure 2

Distribution of manometric diagnosis in controls, EoE, and GERD patients. Weak peristalsis, frequent failed peristalsis, hypertensive peristalsis and rapid contraction with normal latency are present in the 3 groups of subjects in different proportions. The motility disorders were more frequent in EoE and GERD patients (p=0.02) but no significant difference was observed between EoE and GERD patients (p=0.61) The distribution of manometric diagnosis is also shown in the subgroup of GERD patients with negative esophageal biopsies and was not significantly different from that of the EoE patients (p=0.25).

Figure 3

Distribution of the maximal IBP among the controls, EoE and GERD patients. The distribution was significantly different between controls and GERD (p=0.02) and between EoE and GERD (p=0.01), but not between controls and EoE (p=0.1).

Figure 4

Percentage of subjects with pressurization at 25-mmHg isobaric contour for 5, 10, and 20-ml swallows. The number of subjects with pressurization was significantly different among the 3 groups (p=0.04).