A PhysioMechanical Model of Esophageal Function in Eosinophilic Esophagitis.
A PhysioMechanical Model of Esophageal Function in Eosinophilic Esophagitis.
复制标题
嗜酸性粒细胞性食管炎食管功能的物理机械模型。
DOI：
10.1053/j.gastro.2023.05.031
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发表时间：
2023
期刊：
影响因子：
29.4
通讯作者：
Pandolfino,JohnE
中科院分区：
文献类型：
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作者：
Carlson,DustinA;Hirano,Ikuo;Gonsalves,Nirmala;Kahrilas,PeterJ;Araujo,IsisK;Yang,Mira;Tetreault,Marie-Pier;Pandolfino,JohnE
背景和目的嗜酸性粒细胞性食管炎（EoE）以嗜酸性粒细胞性炎症为特征，但也包括纤维狭窄性食管重塑和食管运动障碍。我们的目的是使用功能性管腔成像探针（FLIP）全测量法（即EoE的物理力学分类）来定义和评估EoE的表型。方法在内镜检查期间完成FLIP的EoE患者被纳入一项横断面研究。FLIP研究分析了食管体的扩张平台和顺应性、食管胃交界最大直径和收缩反应模式。然后应用这些FLIP特征来定义物理力学分类。结果共纳入215例EoE患者（平均[标准差]38岁，女性31%）。根据不同的临床特征，包括症状持续时间（P< 0.001）和内镜下EoE参考评分（EREFS） （P< 0.001），确定了7种不同的生理力学分类。特别是，“非反应性纤维狭窄”患者（n = 14）的症状持续时间更长（中位数[四分位数间距]20[10-30]年），并且与“正常”生理力学分类的患者（症状持续时间：3[1-8]年；50名患者中有4名[8%]患有EREFS 2或3级环）相比，更频繁地出现EREFS 2或3级环评分（14名患者中有14名）。此外，在横断面评估未接受治疗的患者中（n = 46），在未来质子泵抑制剂（PPI）应答率（即PPI治疗后每个高倍场粘膜嗜酸性粒细胞计数达到峰值<15）的物理力学分类上存在差异；P = .009。“孤立性食管胃交界流出梗阻”的PPI应答率为87%（15例患者中的13例），而“痉挛反应性纤维狭窄”的PPI应答率为11%（9例患者中的1例）。结论基于FLIP全测量特征对EoE患者的食道物理力学功能进行分类，有助于确定EoE患者的病情严重程度和指导治疗。
Background & AimsEosinophilic esophagitis (EoE) is characterized by eosinophilic inflammation, but also heterogeneous presentations involving fibrostenotic esophageal remodeling and esophageal dysmotility. We aimed to define and evaluate phenotypes of EoE using functional lumen imaging probe (FLIP) panometry (ie, a PhysioMechanical classification of EoE).MethodsPatients with EoE who completed FLIP during endoscopy were included in a cross-sectional study. FLIP studies were analyzed for distensibility plateau and compliance of the esophageal body, maximum esophagogastric junction diameter, and contractile response pattern. These FLIP features were then applied to define PhysioMechanical classifications.ResultsA total of 215 patients with EoE (mean [standard deviation] age 38 [12] years; 31% female) were included. Seven PhysioMechanical classifications were identified that differed by various clinical characteristics, including symptom duration (P< .001) and Endoscopic EoE Reference Scores (EREFS) (P< .001). In particular, patients with “nonreactive fibrostenosis” (n = 14), had greater symptom duration (median [interquartile range] 20 [10–30] years) and more frequently had EREFS grade 2 or 3 ring scores (14 of 14 patients) than patients with a “normal” PhysioMechanical classification (symptom duration: 3 [1–8] years; 4 of 50 [8%] had EREFS grade 2 or 3 rings). In addition, among patients off treatment at cross-sectional evaluation (n = 46), there was a difference between PhysioMechanical classifications in future proton pump inhibitor (PPI) response rates (ie, achieving peak mucosal eosinophil count <15 per high-powered field after PPI treatment);P= .009. PPI response ranged from 87% (13 of 15 patients) with “isolated esophagogastric junction outflow obstruction” to 11% (1 of 9 patients) with “spastic-reactive fibrostenosis.”ConclusionsClassifying PhysioMechanical esophageal function in EoE based on FLIP panometry features may facilitate defining disease severity and directing management in EoE.