■吞咽困难是活动性嗜酸性粒细胞性食管炎(EoE)的常见症状,但有时它仍然存在,尽管达到了组织学愈合和缺乏纤维狭窄的变化。我们旨在描述这一部分患者的测压结果。
■对2013年至2023年三级儿科胃肠病中心的图表进行回顾性回顾,每年治疗约1500名EoE患者。我们纳入了患有EoE的儿童,尽管进行了组织学愈合,但仍进行了高分辨率阻抗测压(HRIM)的持续性吞咽困难(即<15嗜酸性粒细胞/高功率场[Eos/hpf])。包括初始EoE诊断的数据,内窥镜检查报告,食管活检,治疗方案,和HRIM进行回顾性收集。
■在我们的队列中,估计缓解后吞咽困难的患病率非常罕见(<0.05%)。4例患者符合组织学缓解的资格标准,并且在内窥镜评估中没有纤维狭窄特征,因此,包含在这个系列案例中。患者使用类固醇获得缓解,质子泵抑制剂,或两者均在诊断后5个月的中位时间内。缓解时的嗜酸性粒细胞峰值计数在三名患者中为≤5Eos/hpf,在一名患者中为≤10Eos/hpf。在HRIM上,所有4例患者均有食管低动症和异常的推注清除率.3例患者食管下括约肌整合松弛压值正常,1例升高。两名患者被诊断为无效的食管运动,一个有腹水症,一个有1型贲门失弛缓症。
■缓解后吞咽困难在EoE中很少见。食管运动障碍伴低动模式可能导致EoE儿童持续吞咽困难。尽管组织学缓解,但症状持续存在的EoE患者应考虑HRIM。
UNASSIGNED: Dysphagia is a frequent symptom of active eosinophilic esophagitis (
EoE), but at times it persists despite attaining histologic healing and lack of fibro-stenotic changes. We aimed to describe the manometric findings in this subset of patients.
UNASSIGNED: A retrospective review of charts between 2013 and 2023 at a tertiary pediatric gastroenterology center, treating roughly 1500
EoE patients per year. We included children with EoE referred to high-resolution impedance manometry (HRIM) for persistent dysphagia despite histologic healing (i.e., <15 eosinophils/high-power field [Eos/hpf]). Data including initial
EoE diagnosis, endoscopy reports, esophageal biopsies, treatment regimens, and HRIM were retrospectively collected.
UNASSIGNED: The estimated prevalence of post-remission dysphagia in our cohort was exceedingly rare (<0.05%). Four patients met the eligibility criteria of histologic remission and absence of fibro-stenotic features on endoscopic evaluation and thus, were included in this case series. Patients achieved remission with steroids, proton-pump inhibitor, or both within a median time of 5 months from diagnosis. Peak Eosinophil count at remission was ≤5 Eos/hpf in three patients and ≤10 Eos/hpf in one. On HRIM, all four patients had a hypomotile esophagus and abnormal bolus clearance. Lower esophageal sphincter integrated relaxation pressure values were normal in three patients and elevated in one. Two patients were diagnosed with ineffective esophageal motility, one with aperistalsis and one with achalasia type 1.
UNASSIGNED: Post-remission dysphagia is rare in
EoE. Esophageal dysmotility with a hypomotile pattern may contribute to the persistent dysphagia in children with EoE. HRIM should be considered in patients with
EoE in whom symptoms persist despite histologic remission.