UNC Hospitals - Chapel Hill Chapel Hill, NC, United States
Sumana Reddy, MD, MPH1, Corey Ketchem, MD2, Michael Dougherty, MD, MSCR3, Swathi Eluri, MD, MSCR3, Evan S. Dellon, MD, MPH, FACG3 1UNC Hospitals - Chapel Hill, Chapel Hill, NC; 2University of North Carolina, Chapel Hill, NC; 3University of North Carolina School of Medicine, Chapel Hill, NC
Introduction: There is conflicting evidence about the association between eosinophilic esophagitis (EoE) and esophageal motility disorders, as well as whether dysmotility impacts clinical manifestations and treatment. The aim of this study is to evaluate esophageal manometry findings and esophageal dysmotility disorders in patients with EoE.
Methods: We conducted a systematic review using PubMed, EMBASE, and Web of Science. Articles with EoE patients who underwent esophageal manometry were eligible for inclusion. We also included pertinent abstracts from national conferences from 2015-2020. Review articles, editorials, and commentaries were excluded. Clinical, endoscopic, and manometry findings as well as EoE treatment type and response, were extracted. Weighted averages for the proportion of EoE patients with different manometric findings were calculated. An assessment of risk of bias was completed using NIH/NHLBI quality assessment tools.
Results: We identified 755 articles, of which 31 met inclusion criteria (Figure 1A). There were 18 retrospective studies, 8 prospective cohorts, 4 case control studies, and 1 case series, representing a total of 808 patients. A majority of patients with EoE were male and ~33% (range 7-86%) had atopic conditions. Conventional manometry was used in 11 articles, and high-resolution esophageal manometry (HREM) in 20 articles. A total of 7 different esophageal motility disorders were identified (Figure 1B). Ineffective esophageal motility and achalasia were the most common in EoE patients, with weighted averages of 28.3% and 13.9%, respectively. The remaining dysmotility disorders and their weighted averages were fragmented peristalsis (11.7%), EJGOO (6.8%), jackhammer (4.2%), nutcracker (4.1%), distal esophageal spasm (DES) (3.8%), and absent contractility (2.9%). In terms of treatment response, 5/15 articles noted a positive symptom and/or endoscopic response to a PPI trial. Nine out of fourteen studies that used fluticasone for EoE treatment, saw improvement of symptoms and/or endoscopic findings, and two studies noted significant improvement in histologic findings.
Discussion: Discrete esophageal motility disorders were present in a significant percentage of patients with EoE who underwent HREM. Clinical symptoms of EoE may be related to esophageal dysmotility and manometry should be considered for evaluation, particularly in EoE patients with ongoing disease manifestations and symptoms despite treatment.
Figure: Figure 1 - Flowchart for systematic review and prevalence of motility disorders in EoE
Sumana Reddy, MD, MPH1, Corey Ketchem, MD2, Michael Dougherty, MD, MSCR3, Swathi Eluri, MD, MSCR3, Evan S. Dellon, MD, MPH, FACG3. P2404 - Association Between Eosinophilic Esophagitis and Esophageal Dysmotility: A Systematic Review, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.