PS01.016: ESOPHAGEAL DYSMOTILITY CAUSED BY ESOPHAGEAL EOSINOPHILIA REGULATES PATIENTS’ SYMPTOMS AND TREATMENT REQUIREMENTS

Abstract

Abstract Background Only a few studies –none from Asia– have been reported on high-resolution manometry (HRM) assessment of esophageal motor function in eosinophilic esophagitis (EoE). This study aimed to evaluate esophageal motility in Japanese patients with esophageal eosinophil infiltration and to clarify the association between esophageal dysmotility and symptoms, endoscopic findings, severity of eosinophilic infiltration, blood eosinophil count, and response to treatment. Methods Ninety-two patients underwent both esophageal manometry and endoscopic biopsy to determine eosinophil infiltration in esophageal mucosa, looking for esophageal motility disorders, between 2009 and 2016. Of these 92 patients, 18 patients (9 males, mean age, 52.5 years) who had esophageal eosinophilia (≥ 15 eosinophils per high power field)w ere enrolled in this study. Characteristic endoscopic findings included circular rings, linear furrowing, and white exudates. HRM [ManoScan; Given Imaging] was performed and evaluated by Chicago classification ver. 3. Results HRM revealed that 15 patients (83%) had esophageal motility disorders (7 achalasia, 2 esophagogastric junction outflow obstruction (EGJOO), 2 jackhammer esophagus, 1 diffuse esophageal spasm (DES), 3 Ineffective esophageal motility (IEM). Dysphagia was observed in all the patients with achalasia or EGJOO. GERD symptoms like regurgitation or heartburn occurred in most of the patients with EGJOO or IEM. Endoscopic findings of EoE did not differ among types of dysmotility. Severity of esophageal eosinophilia did not correlate with hypercontractile motility disorders. Four patients had blood eosinophilia; none of the achalasia patients or those with normal motility had blood eosinophilia. All the patients, except those with achalasia, were treated with a proton pump inhibitor (PPI). None of the patients with jackhammer esophagus or DES responded to PPI, but one (1/2, 50%) with EGJOO, one (1/3, 33%) with IEM, and two patients (2/3, 66%) with normal motility had their symptom relieved after PPI therapy. Seven patients, including 2 with achalasia, needed steroid therapy either by prednisolone or topical steroid orally. The patients with achalasia showed good temporary response to steroid, though they underwent ordinal myotomy afterwards. One with jackhammer esophagus did not respond to steroid therapy and needed repeated myotomy. Conclusion Symptom was a possible factor to predict a type of esophageal dysmotility. Presence of esophageal dysmotility may affect treatment strategy. Disclosure All authors have declared no conflicts of interest.