Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Gastroenterology. 2023 Sep;165(3):552-563.e4. doi: 10.1053/j.gastro.2023.05.031. Epub 2023 May 30.
BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is characterized by eosinophilic inflammation, but also heterogeneous presentations involving fibrostenotic esophageal remodeling and esophageal dysmotility. We aimed to define and evaluate phenotypes of EoE using functional lumen imaging probe (FLIP) panometry (ie, a PhysioMechanical classification of EoE).
Patients with EoE who completed FLIP during endoscopy were included in a cross-sectional study. FLIP studies were analyzed for distensibility plateau and compliance of the esophageal body, maximum esophagogastric junction diameter, and contractile response pattern. These FLIP features were then applied to define PhysioMechanical classifications.
A total of 215 patients with EoE (mean [standard deviation] age 38 [12] years; 31% female) were included. Seven PhysioMechanical classifications were identified that differed by various clinical characteristics, including symptom duration (P < .001) and Endoscopic EoE Reference Scores (EREFS) (P < .001). In particular, patients with "nonreactive fibrostenosis" (n = 14), had greater symptom duration (median [interquartile range] 20 [10-30] years) and more frequently had EREFS grade 2 or 3 ring scores (14 of 14 patients) than patients with a "normal" PhysioMechanical classification (symptom duration: 3 [1-8] years; 4 of 50 [8%] had EREFS grade 2 or 3 rings). In addition, among patients off treatment at cross-sectional evaluation (n = 46), there was a difference between PhysioMechanical classifications in future proton pump inhibitor (PPI) response rates (ie, achieving peak mucosal eosinophil count <15 per high-powered field after PPI treatment); P = .009. PPI response ranged from 87% (13 of 15 patients) with "isolated esophagogastric junction outflow obstruction" to 11% (1 of 9 patients) with "spastic-reactive fibrostenosis."
Classifying PhysioMechanical esophageal function in EoE based on FLIP panometry features may facilitate defining disease severity and directing management in EoE.
嗜酸性食管炎（EoE）的特征是嗜酸性粒细胞炎症，但也存在涉及纤维性狭窄食管重塑和食管动力障碍的异质表现。我们旨在使用功能内腔成像探头（FLIP）测压法（即 EoE 的生理力学分类）定义和评估 EoE 的表型。
纳入在胃镜检查期间完成 FLIP 的 EoE 患者进行横断面研究。对 FLIP 研究进行分析，以评估食管体的可扩张性平台和顺应性、最大食管胃交界直径和收缩反应模式。然后将这些 FLIP 特征应用于定义生理力学分类。
共纳入 215 例 EoE 患者（平均[标准差]年龄 38[12]岁；31%为女性）。确定了七种生理力学分类，这些分类因各种临床特征而不同，包括症状持续时间（P<0.001）和内镜 EoE 参考评分（EREFS）（P<0.001）。特别是，“非反应性纤维性狭窄”患者（n=14）的症状持续时间更长（中位数[四分位数范围]20[10-30]年），并且更常出现 EREFS 分级 2 或 3 环评分（14 例中的 14 例），而“正常”生理力学分类的患者则较少（症状持续时间：3[1-8]年；50 例中的 4 例[8%]有 EREFS 分级 2 或 3 环）。此外，在横断面评估时停药的患者（n=46）中，生理力学分类之间质子泵抑制剂（PPI）的反应率（即，在 PPI 治疗后达到最高黏膜嗜酸性粒细胞计数<15 个/高倍视野）存在差异；P=0.009。PPI 反应率范围从“孤立的食管胃交界流出梗阻”的 87%（13 例中的 15 例）到“痉挛性反应性纤维性狭窄”的 11%（9 例中的 1 例）。
基于 FLIP 测压法特征对 EoE 的生理力学食管功能进行分类，可能有助于确定疾病严重程度并指导 EoE 的治疗。
