P1342 - Lichenoid Esophagitis: A Clinical Entity with Distinct Manifestations

Award: Presidential Poster Award

Award: Presidential Poster Award

Salima Haque, MD, Keddy Shore, , Kevin O. Turner, DO, Robert M. Genta, MD, FACG
Inform Diagnostics, Irving, TX

Introduction: Lichenoid esophagitis (LichE) has been referred to as an umbrella term to cover a histologic pattern of injury rather than a specific condition. The difficulties to define its clinical expression may derive from its rarity, which prevents assembling cohorts of patients sufficiently large to detect specific, or at least suggestive, clinical patterns. The aim of this study was to use a large national database to collect patients with a histopathologic diagnosis of LichE and compare them to patients with other esophageal diseases.

Methods: Demographic, clinical, and pathologic data from all patients with esophageal biopsies (2008-2020) were extracted from IDEA (Inform Diagnostics Electronic Archives), a national clinicopathologic database. LichE diagnoses were reviewed and detailed information was collected from all confirmed cases. LichE patients were compared to four groups of subjects with the following conditions: 1) Eosinophilic Esophagitis (EoE); 2) Lymphocytic Esophagitis (LyE); 3) Infectious esophagitis (Candida, Herpes, and CMV); and 4) all other patients with conditions ranging from normal to reflux esophagitis. Demographic, endoscopic, and clinical manifestations amongst groups were compared by calculating their odds ratios (OR) and their 95% confidence intervals (95% CI).

Results: There were 911,137 unique patients with esophageal biopsies (median age 57 years; 55% female). Of these, 339 (median age 67 years; 69.6% female) had a diagnosis of LichE. Table 1 shows the most common presenting symptoms for LichE patients and controls. Esophageal strictures were reported in 25.1% of LichE patients, in contrast to 10.0% in those with EoE, 9.4% in LyE, and 4.2% in other controls (p< .0001). LichE patients had the highest rates of dysphagia (63.0%) and odynophagia (9.7%) of all groups and significantly lower rates of GERD than all others except for patients with LyE (42.8% and 42.3%, respectively).

Discussion: LichE patients exhibited highly significant differences in histopathologic features, age, gender, prevalence of endoscopic strictures, and clinical manifestations from all other groups of patients with esophageal biopsies. Some areas of overlap were found only with LyE, possibly explained by overlapping histopathologic features resulting in misclassification. These findings suggest that lichenoid esophagitis may be a distinct entity, in some cases associated with lichenoid skin conditions, but not simply part of a broad spectrum of lymphocytic esophageal diseases.



Disclosures:


Salima Haque, MD, Keddy Shore, , Kevin O. Turner, DO, Robert M. Genta, MD, FACG. P1342 - Lichenoid Esophagitis: A Clinical Entity with Distinct Manifestations, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.