From the Guidelines
Eosinophilic esophagitis (EoE) is more common than esophageal motility disorders in patients with dysphagia and chest pain, with EoE affecting approximately 1 in 2,000 people, while esophageal motility disorders like achalasia are rarer at 1 in 100,000 people. The prevalence of EoE is increasing, and it can occur in both children and adults, with a higher incidence in whites and males, and is often associated with other atopic diseases such as asthma, allergic rhinitis, and eczema 1.
Some key differences between EoE and esophageal motility disorders include:
- EoE is characterized by symptoms such as dysphagia, food impaction, and chest pain, while esophageal motility disorders like achalasia present with dysphagia, regurgitation, and chest pain.
- EoE is diagnosed using endoscopy with biopsy showing ≥15 eosinophils per high-power field, while motility disorders are diagnosed using high-resolution manometry.
- The pathophysiology of EoE is immune-mediated, while motility disorders involve neuromuscular dysfunction of the esophagus.
For EoE treatment, first-line options include proton pump inhibitors (such as omeprazole 20-40mg twice daily for 8 weeks), topical steroids (fluticasone 440-880mcg twice daily or budesonide 1mg twice daily for 8 weeks), and dietary elimination therapy (six-food elimination diet removing dairy, wheat, eggs, soy, nuts, and seafood) 1. Maintenance therapy is typically continued indefinitely. Esophageal motility disorders require different approaches, with achalasia treated with pneumatic dilation, Heller myotomy, or peroral endoscopic myotomy (POEM), and distal esophageal spasm and jackhammer esophagus responding to smooth muscle relaxants like calcium channel blockers (nifedipine 10-30mg) or nitrates.
It's essential to note that the diagnosis and treatment of EoE and esophageal motility disorders have evolved over time, with recent guidelines emphasizing the importance of considering EoE in all adult patients with dysphagia or food bolus obstruction, and the use of esophageal dilation as a treatment option for EoE 1. However, the most recent and highest-quality study on this topic is from 2020, which provides the most up-to-date guidance on the management of EoE 1.
From the Research
Prevalence of Eosinophilic Esophagitis and Esophageal Motility Disorders
- Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus that affects an estimated 34.4/100 000 people in Europe and North America 2.
- Esophageal motility disorders, such as achalasia, can be associated with EoE, but the prevalence of these disorders in patients with EoE is not well established 3, 4.
- Studies have reported that esophageal motility abnormalities are common in patients with EoE, with approximately 1/3 of patients exhibiting motility abnormalities, including ineffective esophageal motility and major motility disorders like achalasia 5, 4.
Comparison of Prevalence
- The prevalence of esophageal motility disorders in the general population is not well established, making it difficult to compare the prevalence of these disorders in patients with EoE 4.
- However, studies suggest that EoE is a significant cause of esophageal motility disorders, particularly in patients with dysphagia and chest pain 6, 3.
- Further research is needed to determine the relative prevalence of EoE and esophageal motility disorders in patients with dysphagia and chest pain.
Treatment of Eosinophilic Esophagitis and Esophageal Motility Disorders
- Treatment of EoE typically involves a step-up approach, including diet changes, proton pump inhibitors, and topical corticosteroids 5, 2.
- Esophageal motility disorders, such as achalasia, may require invasive management, including endoscopic dilation or surgery 3, 4.
- The treatment of esophageal motility disorders in patients with EoE is often tailored to the individual patient's needs and may involve a combination of medical and invasive therapies 6, 5.