Esophageal distensibility as a measure of disease severity in patients with eosinophilic esophagitis

Abstract

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.

Keywords: CSA; DP; DS; Dysphagia; EGJ; EoE; Eosinophilic Esophagitis; Esophageal Distensibility; FLIP; Functional Luminal-Imaging Probe; High-Resolution Impedance Planimetry; PPI; PPI-R-EE; PPI-responsive esophageal eosinophilia; cross-sectional area; distensibility plateau; distensibility slope; eosinophilic esophagitis; esophagogastric junction; functional luminal imaging probe; high-power field; hpf; proton pump inhibitor.

Figure 1

Comparison of the modeled averaged distensibility curves for subject groups. Panel A compares normal subjects to EoE patients and PPI-R-EE patients. Panel B compares patients with and without food impaction at both presentation and follow up.

Figure 2

Comparison of the individual DP values for patients with and without food impaction on presentation (A) and follow-up (B). Note that almost all of the patients with a food impaction had DPs less than 225 mm². Additionally, many patients who did not endorse food impaction on presentation or develop food impaction during follow-up despite having reduced distensibility. The two patients with the lowest DP values (circled) had food impactions on presentation, but did not have food impaction on follow-up due to observing a very restricted diet.