M Ghisa et al. Clin Gastroenterol Hepatol 2021; 19: 1554-1563. Achalasia and Obstructive Motor Disorders Are Not Uncommon in Patients With Eosinophilic Esophagitis

In this study with 109 adults who were newly diagnosed with eosinophilic esophagitis (EoE), the authors consecutively performed high-resolution manometry (HRM). Key findings:

• 68 (62%) had normal findings from HRM
• 8 (7.3%) had achalasia (1 with type 1, 4 with type 2, and 3 with type 3)
• 9 (8.3%) had major motor disorders of esophagus (& not achalasia) and 24 (15.6%) had minor motor disorders

These findings are important because the diagnosis of EoE could result in a diagnostic delay of concurring achalasia and because the presence of esophageal eosinophilia could perhaps play a role in the pathogenesis of achalasia (or vice versa). The finding of achalasia in 7.3% of this population is exponentially higher than the estimated prevalence of achalasia in the general population (10-16 cases per 100,000).

My take: In patients with EoE, further diagnostic workup is indicated if there are persistent symptoms.

Related blog posts:

• Achalasia -More Complexity to Pathophysiology?
• POEM vs Surgical Myotomy for Achalasia
• Achalasia -Updated Epidemiology | gutsandgrowth
• 4-14-4 Rule: More Biopsies Recommended for EoE
• Increased Risk of Eosinophilic Esophagitis with Esophageal Atresia
• Best Approach for Identifying Eosinophilic Esophagitis 
• More Often Than Not Esophagitis in Children with Esophageal Atresia is NOT due to Reflux