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Observational Study
. 2017 Sep;112(9):1466-1473.
doi: 10.1038/ajg.2017.131. Epub 2017 May 16.

Influence of Age and Eosinophilic Esophagitis on Esophageal Distensibility in a Pediatric Cohort

Calies Menard-Katcher  1   2 , Alain J Benitez  3 , Zhaoxing Pan  4 , Faria N Ahmed  1 , Benjamin J Wilkins  5 , Kelley E Capocelli  6 , Chris A Liacouras  7   8 , Ritu Verma  7   8 , Jonathan M Spergel  3   8 , Glenn T Furuta  1   2 , Amanda B Muir  7   8
Affiliations
Observational Study

Influence of Age and Eosinophilic Esophagitis on Esophageal Distensibility in a Pediatric Cohort

Calies Menard-Katcher et al. Am J Gastroenterol. 2017 Sep.

Abstract

Objectives: Sequelae of eosinophilic esophagitis (EoE) include food impaction and esophageal stricture. Duration of inflammation is a predicted risk factor; however, complications remain unpredictable. Studies using the functional lumen imaging probe (FLIP) have demonstrated decreased distensibility of the esophagus in adult patients with EoE. As the impact of inflammation on the developing esophagus is unknown, we investigated esophageal distensibility in a pediatric cohort to determine the effect of age, ongoing inflammation, and fibrotic features on distensibility.

Methods: We conducted a prospective observational study at two tertiary pediatric institutions. Subjects underwent FLIP evaluation during endoscopy to determine distensibility of the esophagus. During stepwise distension, simultaneous intrabag pressure and 16 channels of cross-sectional areas were measured. The minimal diameter at maximal esophageal distention at an intrabag pressure of 40 mm Hg was identified. Distensibility was compared between EoE and non-EoE subjects and between clinical variables within the EoE cohort. Potential confounding variables were identified.

Results: Forty-four non-EoE and 88 EoE subjects aged 3-18 years were evaluated. Age positively correlated with esophageal distensibility in the non-EoE cohort, but this trend was not observed in the EoE population. Subjects with EoE had reduced distensibility even after adjusting for age. Active inflammation (eosinophils >15 eos/high-power field), histological lamina propria fibrosis, and various features of a fibrotic phenotype (stricture, food impaction, circumferential rings on endoscopy) were associated with decreased distensibility within the EoE cohort. FLIP was safe, feasible, and well tolerated.

Conclusions: These findings suggest that remodeling occurs in the pediatric EoE population, warranting early diagnosis and initiation of therapy prior to the onset of disease complications.

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Conflict of interest statement

Conflicts of Interest:

CMK, AJB, ZP, FNA, BJW, KEC, CAL, RV, JMS, ABM: These authors have no relevant conflicts of interest.

GTF: EnteroTrack, UptoDate

Figures

Figure 1
Figure 1
Regression line and prediction intervals for distensibility of the esophageal lumen across age in A) non-EoE controls and B) EoE subjects. Distensibility significantly increases in controls but not in EoE subjects.
Figure 2
Figure 2
Predicted distensibility by age given EoE status using a prediction model without interaction terms (best fit). Diameter increases by 0.33 mm per one year older. Adjusting for age distensibility is reduced in EoE as compared to non-EoE by 26%.(A) Box-whisker plot for distensibility in EoE as compared to non-EoE controls. (B)
Figure 3
Figure 3
Distensibility in EoE subgroups. Mean distensibility is decreased in EoE subjects with; (A) active inflammation (>15 eos/hpf) compared to those with inactive inflammation (<5 eos/hpf); (B) lamina propria fibrosis; (C) endoscopic features of fibrostenosis; (D) recent dysphagia; (E) history of food impaction; (F) history of stricture. Error bars represent SEM. All comparisons were adjusted for age and catheter type.
Figure 4
Figure 4
Lumen diameter versus peak eosinophils per high power fields for all 88 EoE patients. There is a moderate but significant negative correlation between distensibility and peak eosinophil count in EoE subjects.
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Comment in

References

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