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. 2023 Apr 1;14(4):e00564.
doi: 10.14309/ctg.0000000000000564.

The Slender Esophagus: Unrecognized Esophageal Narrowing in Eosinophilic Esophagitis

Kristle L Lynch  1 , Alain J Benitez  2 , Bridget Godwin  2 , Jeremy Klein  2 , Deepika Savant  3 , Benjamin J Wilkins  4 , Calies Menard-Katcher  5 , Craig Gluckman  1 , Gary W Falk  1 , Amanda Muir  2
Affiliations

The Slender Esophagus: Unrecognized Esophageal Narrowing in Eosinophilic Esophagitis

Kristle L Lynch et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Inflammation in eosinophilic esophagitis (EoE) often leads to esophageal strictures. Evaluating esophageal narrowing is clinically challenging. We evaluated esophageal distensibility as related to disease activity, fibrosis, and dysphagia.

Methods: Adult patients with and without EoE underwent endoscopy and distensibility measurements. Histology, distensibility, and symptoms were analyzed.

Results: Patients with EoE had significantly lower distensibilities than controls. We found a cohort with esophageal diameter under 15 mm despite lack of dysphagia.

Discussion: This study raises concern that current assessments of fibrostenosis are suboptimal. We describe a cohort with unrecognized slender esophagus that were identified through impedance planimetry measurements. This tool provides additional information beyond symptomatic, histologic, and endoscopic assessments.

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Conflict of interest statement

Guarantor of the article: Kristle L. Lynch, MD.

Specific author contributions: K.L.L. was involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript and critical revision of the manuscript. A.J.B. was involved in the study concept and design, drafting the manuscript, and critical revision of the manuscript. B.G. was involved in study concept and design, analysis and interpretation of data, and critical revision of the manuscript. J.K. was involved in acquisition and interpretation of data, and critical revision of the manuscript. D.S. was involved in acquisition of data, and critical revision of the manuscript. B.W. was involved in acquisition of data, and critical revision of the manuscript. C.M.-K. was involved in study concept and design, analysis and interpretation of data, and critical revision of the manuscript. C.G. was involved in acquisition and interpretation of data, and critical revision of the manuscript. G.W.F. was involved in study concept and design and critical revision of the manuscript. A.B. was involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript and critical revision of the manuscript.

Financial support: K.L.L. and A.M. supported by Donald Castell American Gastroenterological Association Grant funding. A.M. and C.M.-K. supported by Foundation for the National Institutes of Health (R21TR003039-02).

Potential competing interests: G.W.F. is a consultant for Adare/Ellodi, Allakos, Celgene/Bristol Myers Squibb, Nexstone, Lucid, Regeneron/Sanofi, and Upstream Bio and has research grant support from Adare/Ellodi, Allakos, Arena/Pfizer, Celgene/Bristol Myers Squibb, Lucid, Regeneron/Sanofi, and Shire/Takeda. K.L.L. is a consultant for Medtronic, LUCID, and Takeda. A.M.B. receives research funding from Morphic and Allakos and serves as a consultant for Nexstone and Medtronic. B.G. is currently an employee of Janssen Pharmaceuticals but was not during thewriting of this manuscript. No external companies had any part in the study design, data interpretation, data analysis, nor the decision to submit the article for publication. To the best of our knowledge, no conflict of interest, financial or other, exists.

Figures

Figure 1.
Figure 1.
(a) Comparison of distensibility measurements in patients with eosinophilic esophagitis (EoE) and control patients. Distensibility is significantly lower in patients with EoE, but similar between active and inactive patients with EoE. *P < 0.05. (b) Correlation of distensibility and eosinophil count, R2 = −0.06, P = 0.0502. (c) Correlation of distensibility and fibrosis score, R2 = 0.0017, P = 0.8103.
Figure 2.
Figure 2.
Distensibility of patients with stricture, impaction, and dysphagia. (a) Distensibility of patients with a history of stricture requiring dilation (mean distensibility 15.2 mm) and those without (mean 16.59 mm), P = 0.31. (b) Patients with a history of impaction requiring endoscopic retrieval (mean distensibility 16.17 mm) compared with those without (mean distensibility 16.79 mm), P = 0.4175. (c) Patients with a history of dysphagia in the last 30 days (mean distensibility 16.68 mm) compared with those without (mean distensibility 16.23 mm), P = 0.486. Red circles indicate patients with esophageal caliber <15 mm who have no history of stricture, history of impaction, or dysphagia.
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