A0183 - Complications and Treatment Outcomes of Lymphocytic Esophagitis: Results From a Large Tertiary Care Center Patient Cohort

Sai Rohit R. Mekala, MBBS, Karthik Ravi, MD, Don C. Codipilly, MD, Karan Sachdeva, MBBS, Prasad G. Iyer, MD, FACG
Mayo Clinic, Rochester, MN

Introduction: Lymphocytic esophagitis (LE) is a chronic inflammatory condition characterized by dysphagia and stricturing due to lymphocytic infiltration of the esophagus. LE is rare, has a varied clinical presentation and can be difficult to diagnose, leading to uncertainty regarding potential complications and therapeutic outcomes. We sought to characterize the long term outcomes of patients with lymphocytic esophagitis.

Methods: Patients diagnosed with LE between July 1, 2011 and Dec 30, 2021 at a single tertiary care center were identified. LE was defined by ≥ 10 lymphocytes per high powered field. Basic demographics, comorbidities, endoscopic findings, and therapeutic management were abstracted. Treatment responsive LE was defined by patient reported symptom resolution at last follow-up.

Results: 162 LE patients were identified a mean age at diagnosis of 57.5 (SD: 19.4) years and a slight female predominance (56.8%) (Figure 1). The most common presenting symptom was dysphagia (74.7%) followed by heartburn or reflux (46.9%). Iron deficiency anemia was found in 17.3% of patients, with coexistent Crohn’s disease affecting 14.2% of patients.



Strictures affected 22.8% of patients and were predominantly found in the proximal (37.8%) and mid (59.4%) esophagus. Female gender, odynophagia, weight loss of at >10 kg, and white exudates on endoscopy were associated with esophageal stricture, with these patients also more likely to require endoscopic dilation or topical steroids. (Table 1)



Of 116 patients with follow up, 40 had more than 2 follow-up visits with last 27.5 (23.8) months from presentation. 151 (93.2%) patients reported symptom resolution at last follow-up. 33 (21.9%) improved without specific therapy. Notably, topical steroids were associated with persistent symptoms while observation alone with clinical resolution, suggesting an aggressive LE phenotype. Female gender and extra-esophageal sites of lymphocytic involvement, particularly in the colon, along with PPI treatment were also associated with persistent symptoms.

Discussion: LE has a benign clinical course with a significant number of patients requiring no specific therapy. However, a more aggressive phenotype exists with esophageal strictures relatively common particularly in female patients with exudates on endoscopy. Consequently endoscopic management and medical management should be tailored dependent on presentation.




Disclosures:


Sai Rohit R. Mekala, MBBS, Karthik Ravi, MD, Don C. Codipilly, MD, Karan Sachdeva, MBBS, Prasad G. Iyer, MD, FACG. A0183 - Complications and Treatment Outcomes of Lymphocytic Esophagitis: Results From a Large Tertiary Care Center Patient Cohort, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.