P2385 - Prevalence of Esophageal Motility Disorders in Patients With Eosinophilic Esophagitis

Diana Snyder, MD¹, Catherine Freeman, MBBCh¹, Michael Crowell, PhD¹, Marcelo Vela, MD, MS¹, Karthik Ravi, MD², Brian E. Lacy, MD, PhD, FACG³, Jennifer Horsley-Silva, MD^1
1Mayo Clinic, Scottsdale, AZ; ²Mayo Clinic, Rochester, MN; ³Mayo Clinic, Jacksonville, FL

Introduction: Two previous studies evaluated the association between eosinophilic esophagitis (EoE) and esophageal motility disorders diagnosed by high resolution esophageal manometry (HRM) with conflicting results. A 2011 study found that EoE patients most commonly exhibit normal findings or ineffective esophageal motility (IEM) at similar rates to patients with gastroesophageal reflux disease (GERD). A 2020 study showed an association between EoE and major motor disorders including 7% with achalasia and 5% with esophagogastric junction outflow obstruction (EGJOO). The mechanism behind this association is not well known, but it may be due to accumulation of eosinophils leading to destruction of the myenteric plexus. The aim of our study is to evaluate the prevalence of esophageal motility disorders in EoE patients and clarify whether major motor disorders are frequent in EoE.

Methods: Retrospective analysis of patients diagnosed with EoE from January 2010 to April 2021 at 3 Mayo Clinic tertiary medical centers. Patients with foregut surgery or esophagogastroduodenoscopy (EGD) more than three months from HRM were excluded. Demographics were obtained from chart review. EoE diagnosis was defined based on clinical symptoms, endoscopic reference score (EREFS) and histology with >15 eosinophils per high power field (hpf) in the proximal/middle and distal esophagus. EoE was subclassified at the time of HRM as active or inactive with active disease exhibiting >15 eosinophils/hpf on histology. Motility disorders were defined according to Chicago Classification at the time of study. For patients with EoE and achalasia, endoscopy, histology, and HRM were reviewed by two esophageal experts with consensus to confirm the diagnoses.

Results: Of 110 EoE patients (mean age 50, mean BMI 29.1), 35% had abnormal HRM. The most frequent abnormality was IEM (18%) followed by EGJOO (7.3%). Achalasia type II was found in 4.5%. Motor disorders were significantly more frequent in women (P=0.03); however, 80% of patients with achalasia were men (Table 1). There was no difference in HRM classification based on active or inactive EoE (P=0.93).

Discussion: Over a third of EoE patients have abnormal HRM. The prevalence of achalasia in the general population is about 10 per 100,000 or 0.01%. We found a higher prevalence of achalasia in the EoE population at 4.5% similar to the 2020 European study with a prevalence of 7%. Further evaluation is needed to understand the mechanisms behind this association.



Disclosures:


Diana Snyder, MD¹, Catherine Freeman, MBBCh¹, Michael Crowell, PhD¹, Marcelo Vela, MD, MS¹, Karthik Ravi, MD², Brian E. Lacy, MD, PhD, FACG³, Jennifer Horsley-Silva, MD¹. P2385 - Prevalence of Esophageal Motility Disorders in Patients With Eosinophilic Esophagitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.