P1352 - Lymphocytic Esophagitis: Assessment of the Variable Clinical Presentation

Adam M. Jacob, DO¹, Sanjana Rao, MD², Sun A A. Kim, MD, PhD³, Marie L. Borum, MD, EdD, MPH¹, Samuel A. Schueler, MD^1
1George Washington University School of Medicine and Health Sciences, Washington, DC; ²University of Miami, Jackson Memorial Hospital, Washington, DC; ³The George Washington University, Washington, DC

Introduction: Lymphocytic esophagitis (LE) is a rare disease of unclear etiology, increasing frequency, and variable clinical presentation. LE is defined by peripapillary lymphocytic infiltration into the esophageal squamous epithelium in the absence of significant granulocytic infiltrates. We performed a retrospective review of patients with LE to determine demographics, clinical characteristics, and endoscopic findings to aid clinicians in recognizing this enigmatic disease.

Methods: We reviewed patients who underwent esophagogastroduodenoscopy (EGD) with esophageal biopsies between 12/31/2017 and 03/29/2021 to identify those meeting criteria for LE. We then performed chart review of this cohort to identify demographics, clinical histories, symptoms, and endoscopic findings.

Results: During the study period, 1233 esophageal biopsies were performed, and 18 patients with LE were identified. A majority were male (11/18, 61.1%) with mean age of 55.2 years (± 13.3). The two most common clinical symptoms were heartburn/acid reflux (13/18, 72.2%) and dysphagia (12/18, 66.7%), with all other symptoms occurring in less than half of patients (Table 1). Only 3/18 (16.7%) of patients were taking acid suppressing medication at initial assessment. A majority of patients (14/18, 77.8%) had abnormal endoscopic findings. Almost all (15/18, 83.3%) patients were treated with proton pump inhibitors (PPIs) following endoscopy. Of 9/18 (50.0%) of patients with available follow-up data, 7/9 (77.8%) were treated with PPIs, 6/7 (85.7%) of which had symptom improvement or resolution. In four patients with normal endoscopic findings, 4/4 (100%) reported heartburn and 3/4 (75%) reported dysphagia, and 2/3 (66.6%) with follow-up data had symptom resolution with PPIs.

Discussion: Prior studies indicate that half of patients with LE have dysphagia and 18-47% have heartburn. In our cohort, we found a higher rate of heartburn, which was the most common symptom at presentation (72%). Furthermore, the majority of patients with follow-up data had clinical improvement on PPI therapy, implicating an important association between acid reflux and LE. We also found some patients with normal endoscopies to have symptom resolution with PPIs, highlighting the importance for both gastroenterologists and pathologists to consider and recognize this diagnosis given the potential for symptom resolution with available treatment.



Disclosures:


Adam M. Jacob, DO¹, Sanjana Rao, MD², Sun A A. Kim, MD, PhD³, Marie L. Borum, MD, EdD, MPH¹, Samuel A. Schueler, MD¹. P1352 - Lymphocytic Esophagitis: Assessment of the Variable Clinical Presentation, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.