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Dysmotility in Eosinophilic Esophagitis.

Charmaine Chai1, Usha Krishnan2,3

  • 1Department of Pediatric Gastroenterology, The Children's Hospital at Westmead, Sydney, NSW, Australia.

Frontiers in Pediatrics
|March 17, 2022
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Summary

Eosinophilic esophagitis (EoE) involves esophageal inflammation and eosinophils. This review explores esophageal dysmotility in EoE, its causes, and diagnostic roles for better patient management.

Keywords:
dysphagiaeosinophilic esophagitisesophageal dysmotilitymanometrymotility in children

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pathology

Background:

  • Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal inflammation.
  • Diagnosis requires at least 15 eosinophils per high power field in biopsies, often identified during upper endoscopies.
  • EoE presentation varies by age, from feeding issues in infants to dysphagia and chest pain in adults.

Purpose of the Study:

  • To review the types and prevalence of motor disturbances in EoE.
  • To discuss the pathophysiological basis of EoE-related dysmotility.
  • To outline optimal investigation methods for esophageal dysfunction in EoE, including the role of manometry.

Main Methods:

  • Literature review of studies on EoE, esophageal motility, and diagnostic techniques.
  • Analysis of existing data on EoE prevalence and histopathological findings.
  • Examination of anatomical and functional changes contributing to EoE symptoms.

Main Results:

  • A disconnect exists between esophageal eosinophilia levels and symptom severity, particularly dysphagia.
  • Anatomical changes like strictures and rings are seen in some EoE patients, but many report dysphagia without these findings.
  • Ongoing dysphagia, even with histological remission, suggests underlying esophageal dysmotility.

Conclusions:

  • Esophageal dysmotility is a significant factor in EoE symptomology, often unassessed by standard endoscopy.
  • Manometry plays a crucial role in investigating and managing esophageal dysfunction in EoE patients.
  • Further research into EoE pathophysiology and advanced diagnostic tools is warranted for improved patient outcomes.