食管动力障碍与嗜酸性粒细胞性食管炎的疾病严重程度相关。
Esophageal Dysmotility Is Associated With Disease Severity in Eosinophilic Esophagitis.
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, Chicago, Illinois.
Division of Gastroenterology and Hepatology, Department of Medicine, Chicago, Illinois.
出版信息
Clin Gastroenterol Hepatol. 2022 Aug;20(8):1719-1728.e3. doi: 10.1016/j.cgh.2021.11.002. Epub 2021 Nov 9.
BACKGROUND & AIMS: An association of eosinophilic esophagitis (EoE) with esophageal dysmotility has been described, however, the related mechanism remains unclear. We aimed to evaluate clinical and physiologic characteristics, including esophageal distensibility, associated with secondary peristalsis in patients with EoE.
METHODS
A total of 199 consecutive adult patients with EoE (age, 18-78 y; 32% female) who completed a 16-cm functional luminal imaging probe (FLIP) during endoscopy were evaluated in a cross-sectional study. FLIP panometry contractile response (CR) patterns were classified as normal CR or borderline CR if antegrade contractions were present, and abnormal CRs included impaired/disordered CR, absent CR, or spastic-reactive CR. The distensibility plateau of the esophageal body and esophagogastric junction distensibility was measured with FLIP.
RESULTS
FLIP CR patterns included 68 (34%) normal CR, 65 (33%) borderline CR, 44 (22%) impaired/disordered CR, 16 (8%) absent CR, and 6 (3%) spastic-reactive CR. Compared with normal CRs, abnormal CRs more frequently had reduced esophageal distensibility (distensibility plateau <17 mm in 56% vs 32%), greater total EoE reference scores (median, 5; interquartile range [IQR], 3-6 vs median, 4; IQR, 3-5) with more severe ring scores, and a greater duration of symptoms (median, 10 y; IQR, 4-23 y vs median, 7 y; IQR, 3-15 y). Mucosal eosinophil density, however, was similar between abnormal CRs and normal CRs (median, 34 eosinophils/high-power field [hpf]; IQR, 14-60 eosinophils/hpf vs median, 25 eosinophils/hpf; IQR, 5-50 eosinophils/hpf).
CONCLUSIONS
Although normal secondary peristalsis was observed frequently in this EoE cohort, abnormal esophageal CRs were related to EoE disease severity, especially features of fibrostenosis. This study evaluating secondary peristalsis in EoE suggests that esophageal wall remodeling, rather than eosinophilic inflammatory intensity, was associated with esophageal dysmotility in EoE.
背景与目的
嗜酸细胞性食管炎（EoE）与食管动力障碍有关，但相关机制尚不清楚。本研究旨在评估 EoE 患者中与继发性蠕动相关的临床和生理特征，包括食管扩张性。
方法
对 199 例连续的成人 EoE 患者（年龄 18-78 岁；32%为女性）进行横断面研究，这些患者在胃镜检查期间完成了 16cm 长的功能性腔内成像探头（FLIP）检查。FLIP 压力测压收缩反应（CR）模式分为正常 CR 或如果存在顺行收缩则为临界 CR，异常 CR 包括收缩功能障碍/紊乱 CR、无 CR 或痉挛反应性 CR。用 FLIP 测量食管体和食管胃连接部的扩张平台。
结果
FLIP CR 模式包括 68 例（34%）正常 CR、65 例（33%）临界 CR、44 例（22%）收缩功能障碍/紊乱 CR、16 例（8%）无 CR 和 6 例（3%）痉挛反应性 CR。与正常 CR 相比，异常 CR 更常伴有食管扩张性降低（扩张平台<17mm 占 56%，而 32%）、总 EoE 参考评分更高（中位数 5 分；四分位距 [IQR]，3-6 分 vs 中位数 4 分；IQR，3-5 分），且环分数更高，症状持续时间更长（中位数 10 年；IQR，4-23 年 vs 中位数 7 年；IQR，3-15 年）。然而，异常 CR 与正常 CR 之间的黏膜嗜酸性粒细胞密度相似（中位数 34 个嗜酸性粒细胞/高倍视野 [hpf]；IQR，14-60 个嗜酸性粒细胞/hpf vs 中位数 25 个嗜酸性粒细胞/hpf；IQR，5-50 个嗜酸性粒细胞/hpf）。
结论
尽管在本 EoE 队列中经常观察到正常的继发性蠕动，但异常的食管 CR 与 EoE 疾病严重程度有关，特别是纤维化狭窄的特征。这项评估 EoE 中继发性蠕动的研究表明，与 EoE 食管动力障碍相关的是食管壁重塑，而不是嗜酸性粒细胞炎症强度。
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