AGA Clinical Practice Update on Esophageal Dysfunction Due to Disordered Immunity and Infection: Expert Review

Area of Science:

• Gastroenterology
• Immunology
• Infectious Diseases

Background:

• Infectious and immune-mediated esophageal disorders are often under-diagnosed, leading to esophageal dysfunction and increased healthcare costs.
• These conditions can arise from localized infections/immune diseases or as manifestations of systemic conditions, potentially causing neuromuscular dysfunction.
• A high index of suspicion is crucial for timely diagnosis and effective management.

Purpose of the Study:

• To provide best practice advice (BPA) on diagnostic considerations for immune-mediated esophageal disorders.
• To guide clinicians in evaluating patients presenting with dysphagia, heartburn, and odynophagia.
• To improve patient outcomes by focusing therapeutics and limiting unnecessary procedures.

Main Methods:

• Expert review commissioned and approved by the American Gastroenterological Association (AGA).
• Statements derived from a review of published literature and expert opinion.
• Internal and external peer review process.

Main Results:

• Gastroenterologists should recognize esophageal manifestations of systemic immunologic and infectious diseases.
• Evaluation for immunocompromise is necessary when esophageal infection is identified.
• Consider refractory infection, motility disorders (e.g., in eosinophilic esophagitis), rheumatologic diseases, Crohn's disease, and dermatologic conditions in persistent or specific esophageal symptoms.

Conclusions:

• Awareness of systemic processes is key to diagnosing esophageal dysfunction.
• Early identification and targeted therapy for infectious and immune-mediated esophageal disorders improve patient outcomes.
• Consideration of secondary causes of achalasia, including recent infections and eosinophilic diseases, is important.