PP-11 PROLONGED INTRA-ESOPHAGEAL PH PROFILE AND ESOPHAGEAL MOTILITY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS (EOE).

BACKGROUND: Patients (pts) with eosinophilic esophagitis (EoE), a chronic immune-mediated disorder, may exhibit symptoms of disturbed food transit (i.e. dysphagia, impaction) or mimicking gastro-oesophageal reflux (GOR). We aimed at characterizing in EoE pts the intra-esophageal pH pattern with 24-h multichannel intraluminal impedance (MII-pH) as well as the esophageal motility with high-resolution manometry (EHRM) METHODS:: during a 30 month period we studied 57 patients (pts), median age 11 years (range: 7-16): 25 with EoE, diagnosed according to widely agreed criteria (JPGN 2014;58:107-18; ESPGHAN guidelines) and 32 with GOR disease (GORD). All underwent esophagogastro-duodenoscopy, MII-pH and EHRM. The pH-MII and data analysis were done according to ESPGHAN EURO-PIG protocol (JPGN 2012;55:230-4); variables analysed: reflux index, symptom index, number and type of liquid reflux, number of long lasting reflux episodes, correlation symptom-reflux. The test was diagnostic of GORD if at least ≥ 2 of the previous variables were positive. The EHRM was performed with water perfused catheters and swallow contractile patterns categorized using criteria recently reported by a paediatric group (Am J Gastroenterol 2010;105:460-7). Several motility variables were analysed: esophago-gastric junction (EGJ) morphology, end-expiratory and end-inspiratory EGJ pressure, distal contractile integral (DCI), pressurization front velocity (cm/s), peristaltic propagation pattern.

RESULTS: An abnormal MII-pH profile was markedly more common in GORD pts (27; 84.37%) than in EoE pts (4; 16%; p < 0.001). On the contrary, EHRM irregularities were detected more commonly in EoE that the GORD pts: in particular, when motility tracing were analysed no significant difference for EGJ pressure and deglutitive EGJ relaxation was detected between the 2 groups; however, abnormalities such as peristaltic dysfunction (i.e. failed peristalsis, aperistalsis, and esophageal spasm features) and lower distal contractile integral adjusted for esophageal body length (DCIa) were more common in EoE (17; 68%) than in GORD pts (15; 46.8%) (p < 0.05) CONCLUSIONS:: 1) The great majority of EoE pts have a normal MII-pH profile that doesn't support the use of proton pump inhibitory therapy. 2) EoE pts exhibit higher prevalence of oesophageal motility abnormalities than GORD: this feature is likely sustained by the inflammatory infiltrate that characterizes the esophageal wall in EoE and accounts for the esophageal dysmotility complaints often detected in EoE pts.