Minor Motility Disorders Common in EoE, Says Meta-Analysis

More than half of patients with eosinophilic esophagitis (EoE) present with an esophageal motility disorder, found researchers of a new analysis published in Neurogastroenterology and Motility.

Their findings follow recent data suggesting that esophageal dysmotility may be associated with EoE, which often presents with dysphagia. In the recent systematic review and meta-analysis, 53% had an abnormal motility disorder. The analysis included 400 patients spanning 14 studies using high-resolution manometry (HRM).

“Esophageal dysmotility may be due to smooth muscle dysfunction in EoE that can be induced by the interplay of eosinophils and mast cells. However, it is unclear if this acts alone as a single factor or to what extent associated inflammation, edema, or fibrosis leading to decreased compliance play a role,” explained the researchers. “The pathophysiological mechanisms that promote esophageal dysmotility in patients with EoE are not fully known, although there are several postulated theories. In some achalasia patients, degranulating eosinophils may be the mediators of destruction of myenteric plexus neurons.”

In their study, achalasia was uncommon, present in just 2% of patients. Other major motility disorders, including esophagogastric-junction outflow obstruction (10%) and hypercontractile disorder (1%), were also uncommon. Disorders of peristalsis were also less common in patients. For example, absent contractility was seen in just 5 of 345 patients in 10 studies.

Meanwhile, minor motility disorders, including ineffective esophageal motility (IEM) and fragmented peristalsis, were common in patients. The researchers noted that although IEM was prevalent among patients with EoE (18%), the proportion did not vary significantly from that of controls and patients with EOE did not have an increased risk for IEM compared with controls (odds ratio, 0.83; 95% CI, 0.30-2.27). Both IEM and fragmented peristalsis were found at a similar rate in patients with EoE and controls with gastroesophageal reflux disease.

“The etiology of these motility abnormalities is most likely multifactorial, and further studies are needed to determine the relationship between eosinophilic infiltration and abnormal esophageal motility findings,” explained the researchers. “In particular, HRM and newer techniques such as EndoFLIP should be used prospectively with Chicago 4 Classificationto provide the most up-to-date picture in a prospective fashion. From the clinical standpoint, it would be reasonable to consider esophageal manometry in EoE patients with ongoing dysphagia or chest pain symptoms that persist despite successful histologic and/or endoscopic responses to treatment.”

The researchers flagged the heterogeneity present within and between the studies included in their analysis, noting that their findings should be interpreted with caution. The group also underscored a lack of consistent endoscopic data included in some studies, leaving uncertainty of whether structural changes, such as fibrostenotic disease, was present. These structural changes, explained the researchers, may contribute to some manometric abnormalities seen in esophageal manometry.

Reference

Reddy S, Ketchem C, Dougherty M, Eluri S, Dellon E. Association between eosinophilic esophagitis and esophageal dysmotility: a systematic review and meta-analysis. Neurogastroenterol Motil. Published online September 27, 2022. doi:10.1111/nmo.14475