Tag Archives: esophageal dysmotility

Newsflash Articles: Untreated Eosinophilic Esophagitis Worsens and the Severely-Damaged Esophagus Does Not Work Well

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NC Chang et al. Clin Gastroentol Hepatol 2022; 20: 1701-1708. Open Access! A Gap in Care Leads to Progression of Fibrosis in Eosinophilic Esophagitis Patients

In this retrospective review with 701 patients, 95 (14%) had a gap in care (mean time without care, 4.8 ± 2.3 years). Key findings:

  • Patients post-gap had higher endoscopic severity (2.4 vs 1.5; P < .001) and smaller esophageal diameters (11.0 vs 12.7 mm; P = .04).
  • Strictures were more prevalent with longer gap time (P < .05 for trend). Each additional year of gap time increased odds of stricture by 26%, even after accounting for pre-gap dilation. Additionally, of 67 patients without pre-gap fibrosis, 25 (37%) had at least one fibrotic feature (stricture, narrowing, or requiring dilation) post-gap.

DA Carlson et al. Clin Gastroenterol Hepatol 2022; 20: 1719-1728. Esophageal Dysmotility Is Associated With Disease Severity in Eosinophilic Esophagitis

Consecutive adult patients with EoE (n=199) completed a 16-cm functional luminal imaging probe (FLIP) during endoscopy were evaluated in a cross-sectional study. Key findings:

  • Mucosal eosinophil density was similar between abnormal contractile responses (CRs) and normal CRs (median 34 vs 25)
  • Abnormal CRs more frequently had reduced esophageal distensibility (distensibility plateau <17 mm in 56% vs 32%), with more severe ring scores, and a greater duration of symptoms (median, 10 y vs 7 y)

Thus, abnormal esophageal CRs were related to EoE disease severity, especially features of fibrostenosis. This study suggests that esophageal wall remodeling, rather than eosinophilic inflammatory intensity, was associated with esophageal dysmotility in EoE.

My take: Despite my satirical title, I think these articles are helpful by documenting that ongoing EoE results in worsening esophageal dysfunction/dysmotility (especially if not treated). In addition, they provide insight into the natural history/pathophysiology of EoE.

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Impaired Esophageal Function in Neurologically-Impaired Neonates

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There are a multitude of gastrointestinal problems that develop in infants who have hypoxic-ischemic encephalopathy (HIE).  One of the most pressing needs is determining how best to feed these infants.  A recent study provides more information on the aberrant esophageal function of these infants (J Pediatr 2013; 162: 976-82).

Design:  provocative esophageal manometry was performed in 34 neonates (27 with HIE and 7 controls).  HIE inclusion criteria included the following:

  1. >36 weeks gestational age
  2. acute perinatal event: abruption, cord prolapse, severe fetal heart rate abnormality
  3. signs of encephalopathy per Sarnat staging at birth

The characteristics of the HIE neonates is further defined and divided into those who were treated with hypothermia and those who received traditional care.  All but one infant had an abnormal brain MRI.

Key results:

  • Peristaltic reflexes, upper esophageal sphincter contractile responses (much greater in HIE patients), lower esophageal sphincter relaxation responses (much lower in HIE patients) and esophageal body coordination and clearance were all noted to be abnormal.
  • Infants treated with hypothermia had greater upper esophageal sphincter contractile responses and improved esophageal clearance (noted by decreased peristaltic durations).

Overall, this study demonstrates prolonged and poorly coordinated peristaltic responses in neonates with HIE.  There are no effective treatments for this type of esophageal dysmotility.  As such, even with current management approaches including gastroesophageal reflux medications and fundoplication, children with HIE remain at risk for aerodigestive malfunction and aspiration.

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