Achalasia Examined in Patients With EoE

Achalasia and obstructive motor disorders are not uncommon among patients with eosinophilic esophagitis (EoE), according to new research. This conclusion comes after the researchers found that almost 15% of patients with EoE also had achalasia and obstructive motor disorders, and they required more-invasive therapies.

The study team reviewed data from patients newly diagnosed with EoE and undergoing high-resolution manometry (HRM) from 2011 to 2019 in several different medical centers.

At baseline and throughout the duration of management, demographic, clinical, histological, and endoscopic data were recorded for 109 patients; the mean age of the patients was 37 years, 75% were men, and 62% had normal findings for motor disorders. Of the 41 patients who presented with some form of motor disorder, 17 had a major disorder, 8 of whom were diagnosed with achalasia.

The researchers reported that achalasia was more common among women than men. It also presented with longer delays in diagnosis compared with EoE that did not involve obstructive disorders. Results of clinical and endoscopic tests revealed no significant differences between the cohorts with and without obstructive motor disorders.

The participants without obstructive motor disorders were prescribed proton-pump inhibitors and topical steroids as therapy, while those with motor disorders received pneumatic dilation and myotomy. The researchers defined participants who responded to therapy as those whose esophageal biopsies showed fewer than 15 eosinophils per high power field.

“Invasive achalasia management was required for symptom relief in 50% of patients with achalasia and obstructive motor disorders,” the researchers reported.

Patients without obstructive disorders showed better response to treatment with topical steroids than the group with motor disorders.

 “Patients with EoE who [do] not respond to standard treatments might require targeted muscle disruption,” the researchers concluded.

—Rebecca Mashaw

Reference:

Ghisa M, Laserra G, Marabotto E, et al. Achalasia and obstructive motor disorders are not uncommon in patients with eosinophilic esophagitis. Published online August 4, 2020. Clin Gastroenterol Hepatol. https://doi.org/10.1016/j.cgh.2020.07.056