C0252 - Dysphagia in the Setting of Absent Esophageal Contractility: A Case for Ruling out Eosinophilic Esophagitis

Samantha McPeck, MD¹, Emily Weng, DO¹, Houman Rezaizadeh, MD^2
1University of Connecticut, Farmington, CT; ²University of Connecticut Health Center, Farmington, CT

Introduction: Eosinophilic esophagitis (EoE) is associated with hyper-and hypocontractile motility disorders. Hypotheses exist that suggest causal mechanisms in both directions. This is key as treatment of one entity may improve the other. We present a patient with absent esophageal contractility and symptoms of reflux, dysphagia, and regurgitation which resolved upon treatment of EoE.

Case Description/Methods: A 24-year-old male presented with reflux, dysphagia, and regurgitation. Symptoms were progressive, resulting in a 20-pound weight loss despite proton pump inhibitor and empiric H. pylori treatment. Gastric emptying study was unremarkable, and initial EGD with distal esophageal biopsies were unremarkable with no eosinophils. He presented to our clinic with persistent symptoms and underwent esophageal manometry, notable for absent contractility with low integrated relaxation pressure. Repeat EGD showed a 2-cm segment esophageal mucosal change above the gastroesophageal junction and biopsies with up to 60 eosinophils per high-power field (HPF) consistent with EoE. He began a budesonide slurry with dramatic improvement in symptoms, and complete resolution of symptoms with dairy elimination. Subsequent esophageal biopsies demonstrated less than 15 eosinophils per HPF in all samples. At present, 2.5 years after initial dairy elimination diet, patient maintains dairy avoidance and remains completely asymptomatic.

Discussion: Eosinophilic esophagitis is associated with motility disorders. Mechanisms have been proposed to explain this, including theories that EoE may cause the release ofmyoactive and neuroactive eosinophil secretory products which impact peristalsis and lower esophageal sphincter relaxation, induce tissue remodeling, or disrupt esophageal intramural neurons. Others suggest an inverse relationship wherein stasis from a motility disorder leads to irritation, with cytokine release attracting eosinophils. Thus, guidelines for EoE management recommend ruling out underlying motility disorders. We present a case where symptoms and signs of dysmotility resolved with EoE treatment. This supports the view that evaluation for EoE should be considered in the setting of motility disorders. Clinicians should have an awareness of the association between EoE and motility disorders when evaluating either entity, as EoE requires a high index of suspicion and assurance of adequate biopsies for diagnosis. Several biopsies from two or more esophageal levels are recommended to increase sensitivity of testing.


Disclosures:


Samantha McPeck, MD¹, Emily Weng, DO¹, Houman Rezaizadeh, MD². C0252 - Dysphagia in the Setting of Absent Esophageal Contractility: A Case for Ruling out Eosinophilic Esophagitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.