Distal Esophageal Wall Thickness Linked to Dysphagia in Eosinophilic Esophagitis

Eosinophilic Esophagitis
Eosinophilic Esophagitis
Researchers compared eosinophilic esophagitis and gastroesophageal reflux disease by dysphagia, endoscopic appearance, wall thickness, histology, and motility.

Dysphagia positively correlates with distal esophageal wall thickness among patients with eosinophilic esophagitis (EoE), according to study findings published in Esophagus.

Researchers conducted a prospective trial at an adult tertiary referral hospital in South Australia from February 2012 to April 2021. Researchers used endoscopy, biopsy, high-resolution manometry, and endoscopic ultrasound to observe wall thickness, histology, dysphagia, endoscopic appearance, and motility between patients with EoE vs GERD.

A total of 45 patients, 31 diagnosed with EoE and 14 with GERD, were enrolled in the study. Patients in the EoE and GERD groups had a median age of 41 (IQR, 26) years and 54 (IQR, 26) years, respectively (P =.056). The median dysphagia score was 3 in the EoE group and 0 in the GERD group (P <.001).

Diagnosis of EoE was characterized by at least 15 eosinophils per high powered field accompanied by symptoms of esophageal dysfunction. GERD was defined by heartburn or regurgitation that responded to proton pump inhibitors and by either a positive pH test or a biopsy confirming GERD.

When comparing esophageal wall thickness in both groups, researchers observed that the thickness in the submucosa of the distal esophagus of patients with EoE was higher than in patients with GERD (P =.0003).

In the EoE group, there was a positive correlation found between the thickness of the total distal esophageal wall and dysphagia scores (P =.03).

While there was no connection between disease duration of EoE and dysphagia score or distal esophageal wall thickness, a positive correlation was observed between the disease duration and the thickness of the distal submucosa (P =.01), distal mucosa (P =.03), mid-submucosa (P =.64), and proximal mucosa (P =.01).

In patients with GERD, no significant relationships were observed between dysphagia scores, wall thickness, and the other variables in this study (P =.86).

Study limitations include the single-center design, recall bias, a lack of generalizability due to the inclusion of untreated patients, and the inability to describe the histology of the submucosa.

“Our data indicate that the inflammatory infiltration mainly involves the distal submucosa of the esophagus in EoE, whereas this is evenly spread throughout the affected oesophageal layers in GERD,” the study authors noted. “Thus, the correlation found between dysphagia score and distal total oesophageal wall thickness in EoE appears to be due to the composition of the distal submucosa.”

Reference

Wong S, Tippett M, Zobel J. Distal esophageal wall thickness correlates with dysphagia in adult patients with eosinophilic esophagitis. Esophagus. 2022(19):554-559. doi:10.1007/s10388-022-00924-7