Document Detail


Esophageal Diameter is Decreased in Some Patients with Eosinophilic Esophagitis and Might Increase with Topical Corticosteroid Therapy.
MedLine Citation:
PMID:  22309879     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND AIMS: The rapid response to topical corticosteroids makes it hard to implicate fibrosis as the cause of dysphagia in patients with eosinophilic esophagitis (EoE). We examined surrogates of esophageal expansion using minimal and maximal esophageal diameter (EDmin and EDmax) in barium swallow examinations. METHODS: Eleven patients evaluated at Mayo Clinic Rochester (8 females, median age 40, median diagnosis 36 months, median symptom duration 132 months) underwent barium esophagrams to determine EDmin and EDmax before and after 6 weeks of topical corticosteroid therapy. We assessed parameter reproducibility (in healthy volunteers), baseline EDmin and EDmax, post-corticosteroid changes in EoE patients, and correlation with clinical response. RESULTS: EDmin and EDmax were reproducible, with nonsignificant variance in the 2 esophagrams in controls (P=.44; P=.66, respectively). Baseline EDmax was reduced in EoE at 19 mm (range: 13-26 mm) versus 24 mm (19-29 mm) in controls (P=.004). About 50% of the EoE patients had EDmax and min values within the 10(th) to 90(th) percentile of controls (45% and 55%, respectively). Clinical improvement by Mayo Dsyphagia Questionnaire did not correlate with post-corticosteroid luminal change (p=0.19 for EDmax, p=0.75 for EDmin). Median increases in post-corticosteroid EDmax and EDmin were not statistically significant (P=.15 and .1, respectively). However, they were significant in patients with abnormal baseline EDmax (n=6; 2mm; P=.01) and EDmin (n=5; 3mm; P=.02). CONCLUSIONS: Esophageal diameter is a reproducible parameter that is frequently decreased in EoE, but normal in about 50% of patients. Those with narrowing might respond to steroids, but it is unclear if narrowing causes dysphagia.
Authors:
Joohee Lee; James Huprich; Christine Kujath; Karthik Ravi; Felicity Enders; Thomas Smyrk; David A Katzka; Nicholas J Talley; Jeffrey A Alexander
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-3
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  -     ISSN:  1542-7714     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN.
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