A229 CLINICAL AND ENDOSCOPIC CHARACTERISTICS OF LYMPHOCYTIC ESOPHAGITIS

Abstract

Background

Lymphocytic esophagitis (LE) is a pathologic diagnosis characterized by intraepithelial lymphocytic (IEL) infiltration of the esophageal epithelium. It is a recently acknowledged disease entity, and remains underexplored in the literature. Moreover, the pathophysiology, clinical presentation and endoscopic associations of LE are still unclear.

Aims

To characterize the demographic, clinical, pathologic and endoscopic findings of LE.

Methods

This is a case series conducted at a single academic centre. Patients with histologic findings suggestive of LE from esophageal biopsies done from 2010 to 2016 were identified from a clinical database. Patient demographics, comorbidities, clinical presentations, treatments, imaging findings and endoscopic features were extracted from electronic medical records and descriptive statistics were performed.

Results

Twenty-four patients with LE were identified. The average age was 58.5 and 71% were male. Common comorbidities included HIV (20.8%), asthma (16.7%), and diabetes mellitus (12.5%). The most prevalent clinical presentations were dysphagia (75%), reflux (66.7%), and food bolus obstruction (16.7%). Endoscopy and imaging most frequently demonstrated esophageal rings or webs (50%), esophagitis (20.8%), strictures (20.8%), and furrows (16.7%). In 20.8% of patients, the treating gastroenterologist did not make a definitive clinical diagnosis. Treatments employed included proton pump inhibitors (62.5%), esophageal dilatation (37.5%) and topical steroids (16.7%).

Conclusions

LE occurs predominately in males and a sizeable proportion demonstrate HIV positivity, dysphagia or reflux; frequent endoscopic abnormalities include esophageal rings, webs, and strictures. Treatment approaches were variable, although the most common modalities used were proton pump inhibitors, endoscopic dilatation and topical steroids. Further studies are needed to confirm these findings as well as characterize the natural history and efficacy of treatment modalities for this rare condition.

Funding Agencies

None