Gastroenterology

Gastroenterology

Volume 140, Issue 1, January 2011, Pages 82-90
Gastroenterology

Clinical—Alimentary Tract
Mechanical Properties of the Esophagus in Eosinophilic Esophagitis

https://doi.org/10.1053/j.gastro.2010.09.037Get rights and content

Background & Aims

This study aimed to analyze the mechanical properties of the esophagus in eosinophilic esophagitis (EoE) using the functional luminal imaging probe (EndoFLIP; Crospon Medical Devices, Galway, Ireland).

Methods

Thirty-three EoE patients (22 male; age range, 23–67 years) and 15 controls (6 male; age range, 21–68 years) were included. Subjects were evaluated during endoscopy with the EndoFLIP probe, comprised of a compliant cylindrical bag (maximal diameter 25 mm) with 16 impedance planimetry segments. Stepwise bag distensions from 2 to 40 mL were conducted and the associated intrabag pressure and intraluminal geometry were analyzed.

Results

The EndoFLIP clearly displayed the tubular esophageal geometry and detected esophageal narrowing and localized strictures. Stepwise distension progressively opened the esophageal lumen until a distension plateau was reached such that the narrowest cross-sectional area (CSA) of the esophagus maximized despite further increases in intra-bag pressure. The esophageal distensibility (CSA vs pressure) was reduced in EoE patients (P = .02) with the distension plateau of EoE patients substantially lower than that of controls (median: CSA 267 mm2 vs 438 mm2; P < .01). Mucosal eosinophil count, age, sex, and current proton pump inhibitor treatment did not predict this limiting caliber of the esophagus (P ≥ 0.20).

Conclusions

Esophageal distensibility, defined by the change in the narrowest measurable CSA within the distal esophagus vs intraluminal pressure was significantly reduced in EoE patients compared with controls. Measuring esophageal distensibility may be an important adjunct to the management of EoE, as it is capable of providing an objective means to measure the outcomes of medical or dilation therapy.

Section snippets

Subjects

Fifteen control subjects (6 male; age range, 21–68 years) and 33 patients with EoE (22 male; age range, 19–67 years) were studied. The control subjects were recruited from a pool of asymptomatic volunteers with no gastrointestinal symptoms, previous gastrointestinal surgery, or current use of medications known to affect gastrointestinal function. The patients were recruited from the Gastroenterology Clinic at Northwestern Memorial Faculty Foundation based on previous clinical documentation of

Demographic Data

Before the endoscopy with the EndoFLIP protocol, all EoE patients had previously documented food impaction (14 of 33) and/or symptoms of dysphagia (32 of 33), chest pain (7 of 33), or heartburn (2 of 33). Twenty EoE patients were taking a PPI and 13 subjects were on no treatment at the time of the EndoFLIP procedure.

The most common endoscopic features were rings (33 of 33) and furrows (27 of 33) with a stricture present in 27% of the patients (9 of 33). More than one of these features was

Discussion

This study quantified the distensile properties of the esophagus in patients with EoE using the EndoFLIP, a novel device that utilizes impedance planimetry technology. Luminal diameters of the distal esophagus along with concurrent intraluminal pressure were measured during stepwise distension. The major findings were that: (1) EndoFLIP provided technically successful measurements in all cases; (2) the esophageal distensibility, defined by the change in the narrowest measurable CSA within the

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    This article has an accompanying continuing medical education activity on page e11. Learning Objective: Upon completion of this exam, successful learners will be able to recognize the basis for performing esophageal dilation in patients with eosinophilic esophagitis within the context of clinical presentation and related abnormalities.

    Conflicts of interest Dr Pandolfino is on the Advisory Board for Crospon Inc. This potential conflict of interest was disclosed to the study participants. The remaining authors disclose no conflicts.

    Funding This work was supported by R01 DK56033 (P.J.K.) and R01 DK079902 (J.E.P.) from the Public Health Service; EndoFLIP equipment supported and sponsored by Crospon Ltd., Galway, Ireland.

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