PP‐11 PROLONGED INTRA‐ESOPHAGEAL PH PROFILE AND ESOPHAGEAL MOTILITY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS (EOE)

Abstract

Background:Patients (pts) with eosinophilic esophagitis (EoE), a chronic immune‐mediated disorder, may exhibit symptoms of disturbed food transit (i.e. dysphagia, impaction) or mimicking gastro‐oesophageal reflux (GOR). We aimed at characterizing in EoE pts the intra‐esophageal pH pattern with 24‐h multichannel intraluminal impedance (MII‐pH) as well as the esophageal motility with high‐resolution manometry (EHRM)Methods:during a 30 month period we studied 57 patients (pts), median age 11 years (range: 7–16): 25 with EoE, diagnosed according to widely agreed criteria (JPGN 2014;58:107–18; ESPGHAN guidelines) and 32 with GOR disease (GORD). All underwent esophagogastro‐duodenoscopy, MII‐pH and EHRM. The pH‐MII and data analysis were done according to ESPGHAN EURO‐PIG protocol (JPGN 2012;55:230–4); variables analysed: reflux index, symptom index, number and type of liquid reflux, number of long lasting reflux episodes, correlation symptom‐reflux. The test was diagnostic of GORD if at least ≥ 2 of the previous variables were positive. The EHRM was performed with water perfused catheters and swallow contractile patterns categorized using criteria recently reported by a paediatric group (Am J Gastroenterol 2010;105:460–7). Several motility variables were analysed: esophago‐gastric junction (EGJ) morphology, end‐expiratory and end‐inspiratory EGJ pressure, distal contractile integral (DCI), pressurization front velocity (cm/s), peristaltic propagation pattern.Results:An abnormal MII‐pH profile was markedly more common in GORD pts (27; 84.37%) than in EoE pts (4; 16%; p < 0.001). On the contrary, EHRM irregularities were detected more commonly in EoE that the GORD pts: in particular, when motility tracing were analysed no significant difference for EGJ pressure and deglutitive EGJ relaxation was detected between the 2 groups; however, abnormalities such as peristaltic dysfunction (i.e. failed peristalsis, aperistalsis, and esophageal spasm features) and lower distal contractile integral adjusted for esophageal body length (DCIa) were more common in EoE (17; 68%) than in GORD pts (15; 46.8%) (p < 0.05)Conclusions:1) The great majority of EoE pts have a normal MII‐pH profile that doesn’t support the use of proton pump inhibitory therapy. 2) EoE pts exhibit higher prevalence of oesophageal motility abnormalities than GORD: this feature is likely sustained by the inflammatory infiltrate that characterizes the esophageal wall in EoE and accounts for the esophageal dysmotility complaints often detected in EoE pts.