Delayed Gastric Emptying May Affect a Subset of Patients With Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is characterized by narrowing of the esophagus and dysmotility, but it is unclear whether dysmotility beyond the esophagus is typically present in patients with EoE. A study of children with EoE aimed to provide insight into the relationship between persistent symptoms and delayed gastric emptying.

In the study, which was published online ahead of publication in The Journal of Allergy and Clinical Immunology: In Practice, researchers analyzed gastric emptying nuclear medicine studies of patients with symptoms of EoE, such as early satiety, fullness, bloating, reflux, weight loss, or non-response to therapy. A total of 84 patients with EoE were eligible and had scans available for analysis.

“The rationale behind checking gastric emptying when there was persistent EoE was to understand if delayed gastric emptying could be causing chronic symptoms as the etiology for symptoms or pathogenic reflux as the etiology for persistent esophageal eosinophilia,” the authors wrote.

The patients were divided into 3 groups based on study results. A half emptying time of less than 60 minutes was considered normal, while more than 90 minutes was considered delayed. Results between 60 and 90 minutes were considered borderline. A total of 28 patients fell into the normal cohort, 25 were in the delayed cohort, and 31 were borderline. Average half emptying times were 39 minutes, 74 minutes, and 126 minutes in the normal, borderline, and delayed groups, respectively.

Overall, 56 patients (67%) with persistent EoE symptoms had abnormal gastric emptying study results. The majority of patients in each group were males, but females were more likely to have delayed or borderline gastric emptying compared with males. This finding is in line with previous research demonstrating that females are more likely to have delayed gastric emptying than males.

A total of 23 patients—16 with delayed gastric emptying, 5 who were borderline, and 2 whose scans were normal—were treated with erythromycin to improve motility. Five of these patients displayed clear improvement with treatment.

At the time of nuclear medicine scanning, there were no significant differences in esophageal eosinophilia between the normal, borderline, or delayed gastric emptying groups. Each group had similar rates of gastroesophageal junction erosions, and symptoms were variable throughout the groups.

“Interestingly, there were fewer gastroesophageal junction erosions in the delayed group, suggesting a non-motility, and potentially non-reflux, based etiology for erosions,” the authors wrote. Patients in the delayed group were more likely to experience constipation than the other groups, however.

Although the findings of this study suggest clinical features and persistent symptoms can help identify EoE patients who may need gastric emptying studies, more research is needed to confirm the benefit. The data also support the notion that a child with delayed gastric emptying and constipation concurrently might have more widespread dysmotility requiring diagnosis and treatment.

Reference

Khosh-Hemmat E, Babbel J, Chaiboonma K, Dohil R, Aceves SS. A subset of patients with eosinophilic esophagitis demonstrate delayed gastric emptying. J Allergy Clin Immunol Pract. Published online June 29, 2022. doi:10.1016/j.jaip.2022.06.021