Eosinophilic esophagitis and esophageal acalasia

Authors

Keywords:

eosinophilic esophagitis, esophageal achalasia, Heller myotomy, motility disorders

Abstract

Introduction: Eosinophilic esophagitis is an emerging disease characterized by infiltration of the esophagus by eosinophilic leukocytes. Its main symptoms are dysphagia and frequent food impaction in the esophagus. Scientific evidence is now available that recognizes the disease as the possible cause of unfavorable evolution in patients undergoing Heller myotomy.

Objective: Describe the biomolecular evidence associating eosinophilic esophagitis to esophageal achalasia.

Methods: A systematic critical review was conducted of the evidence about biomolecular mechanisms associated to eosinophilic esophagitis and esophageal achalasia. The articles consulted were published in the databases PubMed, SciELO, LILACS and Scopus from 2015 to 2020.

Data analysis and integration: A discussion is provided about crucial questions published recently concerning the study topic: Can eosinophilic esophagitis and esophageal achalasia coexist? Does eosinophilic esophagitis influence the result of esophageal achalasia treatment? What studies are required to establish the relationship between the two conditions?

Conclusions: The cellular and biomolecular mechanisms triggered by eosonophilic infiltration contextualize the etiological and pathophysiological difference between eosinophilic esophagitis and esophageal achalasia. This explains the unfavorable post-myotomy evolution of patients and encourages the conduct of prospective controlled studies aimed at enhancing quality of life.

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Author Biographies

Rosalba Roque Gonzalez, Centro Nacional de Cirugía de Minímo Acceso

Doctor en Ciencias Médica. Especialista de Segundo Grado en Cirugía General. Máster en Educación Médica. Profesor e  Investigador Titular. Miembro Titular de la Sociedad Cubana de Cirugía. Centro Nacional de Cirugía de Mínimo Acceso.

Felipe Neri Piñol Jimenez, Centro Nacional de Cirugía de Minímo Acceso

Doctor en Ciencias. Doctor en Ciencias Médicas. Especialista de Segundo Grado en Gastroenterología. Máster en Enfermedades Infecciosas. Profesor e Investigador Titular. Miembro Titular de la Sociedad Cubana de Gastroenterología. Miembro Internacional del Colegio Americano de Gastroenterología y de la Sociedad Americana de Gastroenterología-Endoscopia.

Vivianne María Anido Escobar, Centro Nacional de Cirugía de Minímo Acceso

Doctor en Ciencias Médicas, Profesor e Investigador Titular. Especialista de Segundo Grado en Gastroenterología. Miembro Titular de la Sociedad Cubana de Gastroenterología.

References

1. Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018;31(9):1-29. DOI: 10.1093/dote/doy071

2. Roque González R, Martínez Alfonso MÁ, Torres Peña R, Anido Escobar V, Naranjo Hernández D, Díaz Drake Z. Miotomía de Heller laparoscópica para el tratamiento de la acalasia esofágica en el adulto mayor. Rev Cubana Cir. 2015 [acceso: 22/06/2020]; 54(4):309-17. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932015000400003&nrm=iso

3. Roque González R, Martínez Alfonso MÁ, Pereira Fraga JG, Villanueva Ramos A, Jiménez Ramos R, Anido Escobar V. Reintervenciones por fracaso de la miotomía de Heller por acalasia esofágica. Rev Cubana Cir. 2017 [acceso: 22/06/2020]; 56(4):1-9. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932017000400002&nrm=iso

4. Patel DA, Kim HP, Zifodya JS, Vaezi MF. Idiopathic (primary) achalasia: a review. Orphanet J Rare Dis. 2015;10(1):89. DOI: 10.1186/s13023-015-0302-1

5. Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ. Classifying Esophageal Motility by Pressure Topography Characteristics: A Study of 400 Patients and 75 Controls. Am J Gastroenterol. 2008 [acceso: 22/06/2020]; 103(1). Disponible en: https://journals.lww.com/ajg/Fulltext/2008/01000/Classifying_Esophageal_Motility_by_Pressure.6.aspx

6. Kahrilas PJ. Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed? Am J Gastroenterol. 2010;105(5):981-7. PMCID: PMC2888528

7. Goldblum JR, Rice TW, Richter JE. Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology. 1996;111(3):648-54. DOI: 10.1053/gast.1996.v111.pm8780569

8. Weiss AH, Iorio N, Schey R. Esophageal motility in eosinophilic esophagitis. Rev Gastroenterol Méx. 2015;80(3):205-13. DOI: 10.1016/j.rgmx.2015.05.005

9. Lucendo AJ, Molina-Infante J, Arias Á, von Arnim U, Bredenoord AJ, Bussmann C, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J. 2017;5(3):335-58. DOI: 10.1177/2050640616689525

10. Simon D, Straumann A, Schoepfer AM, Simon H-U. Current concepts in eosinophilic esophagitis. Allergo J Int. 2017;26(7):258-66. DOI: 10.1007/s40629-017-0037-11

11. Landres RT, Kuster GGR, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978 [acceso: 22/06/2020]; 74(6):1298-301. Disponible en: http://www.sciencedirect.com/science/article/pii/0016508578907102

12. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG Clinical Guideline: Evidenced Based Approach to the Diagnosis and Management of Esophageal Eosinophilia and Eosinophilic Esophagitis (EoE). Am J Gastroenterol. 2013 [acceso: 2020 Jun 30];108(5):679-92. Disponible en: https://journals.lww.com/ajg/Fulltext/2013/05000/ACG_Clinical_Guideline__Evidenced_Based_Approach.10.aspx

13. Cauble EW, Rife C, Singh ER, Arevalo LF, Freeman J, Lopes-Virella MF, et al. 432 Evidence That Achalasia Involves a Systemic Inflammatory Response. Gastroenterology. 2012;142(5). DOI: 10.1016/S0016-5085(12)60367-9

14. Clayton F, Peterson K. Eosinophilic Esophagitis: Pathophysiology and Definition. Gastrointest Endosc Clin N Am. 2018;28(1):1-14. DOI: 10.1016/j.giec.2017.07.011

15. Palmieri O, Mazza T, Merla A, Fusilli C, Cuttitta A, Martino G, et al. Gene expression of muscular and neuronal pathways is cooperatively dysregulated in patients with idiopathic achalasia. Sci Rep. 2016;6(1):31549. DOI: 10.1038/srep31549

16. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. The Lancet. 2014 [acceso: 30/06/2020]; 383(9911):83-93. Disponible en: http://www.sciencedirect.com/science/article/pii/S0140673613606510

17. Clayton S, Cauble E, Kumar A, Patil N, Ledford D, Kolliputi N, et al. Plasma levels of TNF-α, IL-6, IFN-γ, IL-12, IL-17, IL-22, and IL-23 in achalasia, eosinophilic esophagitis (EoE), and gastroesophageal reflux disease (GERD). BMC Gastroenterol. 2019 [acceso: 30/06/2020]; 19:28. Disponible en: https://link.springer.com/article/10.1186/s12876-019-0937-9

18. Jin H, Wang B, Zhang L-L, Zhao W. Activated Eosinophils are Present in Esophageal Muscle in Patients with Achalasia of the Esophagus. Med Sci Monit. 2018 [acceso: 30/06/2020]; 24:2377-83. PMCID: PMC5928914

19. Mandaliya R, DiMarino AJ, Cohen S. Association of achalasia and eosinophilic esophagitis. Indian J Gastroenterol. 2013;32(1):54-7. DOI: 10.1007/s12664-012-0255-4

20. Nakajima N, Sato H, Takahashi K, Hasegawa G, Mizuno K, Hashimoto S, et al. Muscle layer histopathology and manometry pattern of primary esophageal motility disorders including achalasia. Neurogastroenterol Motil. 2017;29(3):e12968. DOI: 10.1111/nmo.12968

21. Spechler SJ, Konda V, Souza R. Can eosinophilic esophagitis cause achalasia and other esophageal motility disorders? Am J Gastroenterol. 2018 [acceso: 07/06/2020]; 113(11):1594-9. Disponible en: https://journals.lww.com/ajg/Abstract/2018/11000/Can_Eosinophilic_Esophagitis_Cause_Achalasia_and.14.aspx.

Published

2021-10-27

How to Cite

1.
Roque Gonzalez R, Piñol Jimenez FN, Anido Escobar VM. Eosinophilic esophagitis and esophageal acalasia. Rev Cubana Inv Bioméd [Internet]. 2021 Oct. 27 [cited 2025 Aug. 23];40(3). Available from: https://revibiomedica.sld.cu/index.php/ibi/article/view/1097

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Section

ARTÍCULOS DE REVISIÓN