Korean J Gastroenterol.  2019 Jun;73(6):322-326. 10.4166/kjg.2019.73.6.322.

Emerging Issues in Esophageal Motility Diseases

• Kim GH
• Jung KW

• KMID: 2454092
• DOI: http://doi.org/10.4166/kjg.2019.73.6.322

Abstract

With the advances in technology and medical knowledge, new diseases are being identified and investigated. Esophageal motility disorders have been re-defined using high-resolution manometry and their pathogenesis are being better understood. The use of opioid analgesics is increasing worldwide, particularly in the United States, but their chronic use can cause opioid-induced esophageal dysfunction, which mimics spastic motor disorders, including achalasia type 3 or 2 and esophagogastric junction outflow obstruction. Eosinophilic esophagitis is identified by eosinophilic infiltration confirmed on a pathological examination. The condition is often associated with esophageal motility abnormalities. On the other hand, recent studies have suggested that muscle-predominant eosinophilic infiltration, eosinophilic esophageal myositis, might manifest as spastic motor disorders, including achalasia or jackhammer esophagus. Lymphocytic esophagitis is an unusual esophageal condition, which is confirmed by the increased number of lymphocytes in the esophageal epithelium. Although several reports have supported the existence of lymphocytic esophagitis, it is still unclear whether lymphocytic esophagitis is a distinct disease entity or another spectrum of other esophageal diseases, such as gastroesophageal reflux disease or eosinophilic esophagitis. This review presents evidence and reports on the emerging issues in esophageal motility disorders, including opioid-induced esophageal dysfunction, eosinophilic esophagitis with eosinophilic esophageal myositis, and lymphocytic esophagitis.

Keyword

Esophageal dysfunction; Eosinophilic esophagitis; Eosinophilic esophageal myositis; Opioid-induced esophageal dysfunction; Lymphocytic esophagitis

MeSH Terms

Analgesics, Opioid
Eosinophilic Esophagitis
Eosinophils
Epithelium
Esophageal Achalasia
Esophageal Diseases
Esophageal Motility Disorders
Esophagitis
Esophagogastric Junction
Esophagus
Gastroesophageal Reflux
Hand
Lymphocytes
Manometry
Motor Disorders
Muscle Spasticity
Myositis
United States
Analgesics, Opioid

Reference

1. Camilleri M, Lembo A, Katzka DA. Opioids in gastroenterology: treating adverse effects and creating therapeutic benefits. Clin Gastroenterol Hepatol. 2017; 15:1338–1349.

2. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015; 156:569–576.

3. Choung RS, Locke GR 3rd, Zinsmeister AR, Schleck CD, Talley NJ. Opioid bowel dysfunction and narcotic bowel syndrome: a population-based study. Am J Gastroenterol. 2009; 104:1199–1204.

4. Camilleri M. Opioid-induced constipation: challenges and therapeutic opportunities. Am J Gastroenterol. 2011; 106:835–842. quiz 843.

5. Wood JD, Galligan JJ. Function of opioids in the enteric nervous system. Neurogastroenterol Motil. 2004; 16:Suppl 2. 17–28.

6. Pasternak GW. Pharmacological mechanisms of opioid analgesics. Clin Neuropharmacol. 1993; 16:1–18.

7. Bagnol D, Mansour A, Akil H, Watson SJ. Cellular localization and distribution of the cloned mu and kappa opioid receptors in rat gastrointestinal tract. Neuroscience. 1997; 81:579–591.

8. Penagini R, Bianchi PA. Effect of morphine on gastroesophageal reflux and transient lower esophageal sphincter relaxation. Gastroenterology. 1997; 113:409–414.

9. Dowlatshahi K, Evander A, Walther B, Skinner DB. Influence of morphine on the distal oesophagus and the lower oesophageal sphincter--a manometric study. Gut. 1985; 26:802–806.

10. Kraichely RE, Arora AS, Murray JA. Opiate-induced oesophageal dysmotility. Aliment Pharmacol Ther. 2010; 31:601–606.

11. Ratuapli SK, Crowell MD, DiBaise JK, et al. Opioid-induced esophageal dysfunction (OIED) in patients on chronic opioids. Am J Gastroenterol. 2015; 110:979–984.

12. Ravi K, Murray JA, Geno DM, Katzka DA. Achalasia and chronic opiate use: innocent bystanders or associated conditions? Dis Esophagus. 2016; 29:15–21.

13. Jung KW, Kraichely RE, Arora AS, Katzka DA, Romero Y, Murray JA. Manometric characteristics of opioid esophageal dysmotility disorder by high-resolution manometry. Gastroenterology. 2011; 140:S–229.

14. Jung KW, Myung SJ, Jung HY. A patient with dysphagia associated with opioid medication. J Neurogastroenterol Motil. 2012; 18:220–221.

15. Patel D, Vaezi M. Opioid-induced esophageal dysfunction: an emerging entity with sweeping consequences. Curr Treat Options Gastroenterol. 2018; 16:616–621.

16. Kim GH, Jung KW. The role of opioids and alcohol in the development of achalasia type III and esophagogastric junction outflow obstruction. J Neurogastroenterol Motil. 2019; 25:177–178.

17. Kim GH, Jung KW, Jung HY, et al. Superior clinical outcomes of peroral endoscopic myotomy compared with balloon dilation in all achalasia subtypes. J Gastroenterol Hepatol. 2019; 34:659–665.

18. Murray JA, Ledlow A, Launspach J, Evans D, Loveday M, Conklin JL. The effects of recombinant human hemoglobin on esophageal motor functions in humans. Gastroenterology. 1995; 109:1241–1248.

19. Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference. Gastroenterology. 2018; 155:1022–1033.e10.

20. Schoepfer AM, Simko A, Bussmann C, et al. Eosinophilic esophagitis: relationship of subepithelial eosinophilic inflammation with epithelial histology, endoscopy, blood eosinophils, and symptoms. Am J Gastroenterol. 2018; 113:348–357.

21. Katzka DA. Eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2018; 28:xi.

22. Kim GH, Jung KW, Jung HY, et al. Diagnostic trends and clinical characteristics of eosinophilic esophagitis: a Korean, single-center database study. J Neurogastroenterol Motil. 2018; 24:248–254.

23. Nurko S, Rosen R, Furuta GT. Esophageal dysmotility in children with eosinophilic esophagitis: a study using prolonged esophageal manometry. Am J Gastroenterol. 2009; 104:3050–3057.

24. Moawad FJ, Maydonovitch CL, Veerappan GR, Bassett JT, Lake JM, Wong RK. Esophageal motor disorders in adults with eosinophilic esophagitis. Dig Dis Sci. 2011; 56:1427–1431.

25. Roman S, Hirano I, Kwiatek MA, et al. Manometric features of eosinophilic esophagitis in esophageal pressure topography. Neurogastroenterol Motil. 2011; 23:208–214. e111

26. van Rhijn BD, Oors JM, Smout AJ, Bredenoord AJ. Prevalence of esophageal motility abnormalities increases with longer disease duration in adult patients with eosinophilic esophagitis. Neurogastroenterol Motil. 2014; 26:1349–1355.

27. Goldblum JR, Whyte RI, Orringer MB, Appelman HD. Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol. 1994; 18:327–337.

28. Goldblum JR, Rice TW, Richter JE. Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology. 1996; 111:648–654.

29. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine (Baltimore). 1970; 49:299–319.

30. Spechler SJ, Konda V, Souza R. Can eosinophilic esophagitis cause achalasia and other esophageal motility disorders? Am J Gastroenterol. 2018; 113:1594–1599.

31. Sato H, Nakajima N, Takahashi K, et al. Proposed criteria to differentiate heterogeneous eosinophilic gastrointestinal disorders of the esophagus, including eosinophilic esophageal myositis. World J Gastroenterol. 2017; 23:2414–2423.

32. Sato H, Terai S. Eosinophilic esophageal myositis (EoEM) causes jackhammer esophagus, rarely posing a problem in the differential diagnosis of eosinophilic esophagitis. Am J Gastroenterol. 2018; 113:1263–1264.

33. Savarino E, Gemignani L, Zentilin P, et al. Achalasia with dense eosinophilic infiltrate responds to steroid therapy. Clin Gastroenterol Hepatol. 2011; 9:1104–1106.

34. Nakajima N, Sato H, Takahashi K, et al. Muscle layer histopathology and manometry pattern of primary esophageal motility disorders including achalasia. Neurogastroenterol Motil. 2017; 29:e12968.

35. Hejazi RA, Reddymasu SC, Sostarich S, McCallum RW. Disturbances of esophageal motility in eosinophilic esophagitis: a case series. Dysphagia. 2010; 25:231–237.

36. Nennstiel S, Bajbouj M, Becker V, et al. High-resolution manometry in patients with eosinophilic esophagitis under topical steroid therapy-a prospective observational study (HIMEOS-study). Neurogastroenterol Motil. 2016; 28:599–607.

37. Rubio CA, Sjödahl K, Lagergren J. Lymphocytic esophagitis: a histologic subset of chronic esophagitis. Am J Clin Pathol. 2006; 125:432–437.

38. Nguyen AD, Dunbar KB. How to approach lymphocytic esophagitis. Curr Gastroenterol Rep. 2017; 19:24.

39. Haque S, Genta RM. Lymphocytic oesophagitis: clinicopathological aspects of an emerging condition. Gut. 2012; 61:1108–1114.

40. Sutton LM, Heintz DD, Patel AS, Weinberg AG. Lymphocytic esophagitis in children. Inflamm Bowel Dis. 2014; 20:1324–1328.

41. Pasricha S, Gupta A, Reed CC, Speck O, Woosley JT, Dellon ES. Lymphocytic esophagitis: an emerging clinicopathologic disease associated with dysphagia. Dig Dis Sci. 2016; 61:2935–2941.

42. Cohen S, Saxena A, Waljee AK, et al. Lymphocytic esophagitis: a diagnosis of increasing frequency. J Clin Gastroenterol. 2012; 46:828–832.

43. Wang HH, Mangano MM, Antonioli DA. Evaluation of T-lymphocytes in esophageal mucosal biopsies. Mod Pathol. 1994; 7:55–58.

44. Niewiarowski TJ, Stoll LM. Recurrent dysphagia in a patient with chronic lymphocytic esophagitis. Gastrointest Endosc. 2016; 84:1071–1072.

45. Purdy JK, Appelman HD, Golembeski CP, McKenna BJ. Lymphocytic esophagitis: a chronic or recurring pattern of esophagitis resembling allergic contact dermatitis. Am J Clin Pathol. 2008; 130:508–513.

46. Kasirye Y, John A, Rall C, Resnick J. Lymphocytic esophagitis presenting as chronic dysphagia. Clin Med Res. 2012; 10:83–84.

47. Mandaliya R, Dimarino AJ, Cohen S. Lymphocytic esophagitis mimicking eosinophilic esophagitis. Ann Gastroenterol. 2012; 25:355–357.

48. Hendy PJ, Wong DS, Florin TH. Spontaneous oesophageal perforation: an unreported complication of lymphocytic oesophagitis. Gut. 2013; 62:1668–1669.

49. Figueiredo PC, Pinto-Marques P, Borralho P, Freitas J. Unusual cause for smoldering dysphagia. Lymphocytic esophagitis. Dysphagia. 2014; 29:283–285.

50. Ebach DR, Vanderheyden AD, Ellison JM, Jensen CS. Lymphocytic esophagitis: a possible manifestation of pediatric upper gastrointestinal Crohn's disease. Inflamm Bowel Dis. 2011; 17:45–49.