Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
Gastroenterology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy.
Clin Gastroenterol Hepatol. 2021 Aug;19(8):1554-1563. doi: 10.1016/j.cgh.2020.07.056. Epub 2020 Aug 4.
An association has been reported between achalasia and eosinophilic esophagitis (EoE). We performed a retrospective study of high-resolution manometry (HRM) patterns in a large cohort of patients with EoE.
We collected data from consecutive patients with a new diagnosis of EoE from 2012 through 2019 undergoing HRM during the initial assessment at different centers in Italy. Demographic, clinical, endoscopic and histological characteristics were recorded at baseline and during management. Diagnoses of EoE and esophageal motility disorders were made according to established criteria. Treatments offered included proton pump inhibitors and topical steroids for EoE, and pneumatic dilation and myotomy for achalasia. Response to therapy was defined as less than 15 eosinophils per high power field in esophageal biopsies.
Of 109 consecutive patients (mean age 37 years, 82 male), 68 (62%) had normal findings from HRM. Among 41 patients with motor disorders, 24 (59%) had minor motor disorders and 17 (41%) presented with major motor disorders, including 8 with achalasia (1 with type 1, 4 with type 2, and 3 with type 3). Achalasia and nonachalasia obstructive motor disorders had 14.7% prevalence among patients with EoE. Achalasia was more frequent in women, with longer diagnostic delay and abnormal esophagogram (P < .05) compared with EoE without achalasia or obstructive motor disorders. Clinical features and endoscopic findings did not differ significantly between patients with EoE with vs without achalasia and obstructive motor disorders. A higher proportion of patients without achalasia and obstructive motor disorders responded to topical steroids than patients with these features (P < .005). Invasive achalasia management was required for symptom relief in 50% of patients with achalasia and obstructive motor disorders.
Achalasia and obstructive motor disorders are found in almost 15% of patients with EoE, and esophageal eosinophilia might cause these disorders. Patients with EoE who do not respond to standard treatments might require targeted muscle disruption.
已报道贲门失弛缓症（achalasia）与嗜酸性食管炎（eosinophilic esophagitis，EoE）之间存在关联。我们对一大组 EoE 患者进行了高分辨率测压（high-resolution manometry，HRM）模式的回顾性研究。
我们收集了 2012 年至 2019 年期间在意大利不同中心接受 HRM 初始评估的新发 EoE 患者的数据。记录了基线时和治疗期间的人口统计学、临床、内镜和组织学特征。根据既定标准诊断 EoE 和食管动力障碍。提供的治疗包括质子泵抑制剂和局部皮质类固醇治疗 EoE，以及气动扩张和肌切开术治疗贲门失弛缓症。治疗反应定义为食管活检中每高倍镜视野的嗜酸性粒细胞少于 15 个。
109 例连续患者（平均年龄 37 岁，82 例男性）中，68 例（62%）HRM 结果正常。41 例存在运动障碍的患者中，24 例（59%）存在轻度运动障碍，17 例（41%）存在重度运动障碍，其中 8 例为贲门失弛缓症（1 例为 1 型，4 例为 2 型，3 例为 3 型）。EoE 患者中贲门失弛缓症和非贲门失弛缓症阻塞性运动障碍的患病率为 14.7%。与非贲门失弛缓症或非阻塞性运动障碍的 EoE 患者相比，贲门失弛缓症患者中女性更为常见，诊断延迟时间更长，食管造影异常（P<.05）。贲门失弛缓症与非贲门失弛缓症和非阻塞性运动障碍患者的临床特征和内镜检查结果无显著差异。与具有这些特征的患者相比，无贲门失弛缓症和非阻塞性运动障碍的患者对局部皮质类固醇的反应比例更高（P<.005）。50%的贲门失弛缓症和阻塞性运动障碍患者需要进行有创性贲门失弛缓症治疗以缓解症状。
贲门失弛缓症和阻塞性运动障碍在近 15%的 EoE 患者中发现，食管嗜酸性粒细胞增多可能导致这些疾病。对标准治疗无反应的 EoE 患者可能需要针对特定肌肉的破坏。
