Assessment of esophageal motility in patients with eosinophilic esophagitis: A scoping review

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder characterized by eosinophilic infiltration of the esophageal mucosa, leading to symptoms such as dysphagia and food impaction. While histologic and endoscopic features are well established, the impact of EoE on esophageal motility has gained increasing attention. This narrative review evaluates current evidence on esophageal motility abnormalities in EoE, focusing on diagnostic modalities including high-resolution manometry (HRM), functional lumen imaging probe (FLIP), and impedance measurements. Chronic inflammation and subepithelial fibrosis in EoE alter esophageal biomechanics, resulting in diverse motility abnormalities such as ineffective esophageal motility, fragmented peristalsis, panesophageal pressurization, and occasional achalasia-like patterns. HRM has emerged as a key tool for detecting these abnormalities, although interpretation remains challenging due to heterogeneity and lack of disease-specific patterns. Advanced techniques such as FLIP and impedance measurements provide additional insights by assessing esophageal distensibility and bolus transit, demonstrating reduced compliance and impaired bolus clearance that correlate with symptom severity and risk of food impaction. Esophageal motility assessment is essential for the comprehensive evaluation of EoE, particularly in patients with persistent or refractory symptoms. Integration of functional, histologic, and clinical findings is crucial for individualized management. Further research is needed to standardize diagnostic criteria and optimize therapeutic strategies based on motility assessment.