400 Clinical Overlap Between Lymphocytic Esophagitis and Reflux Esophagitis With Increased Lymphocytic Infiltration

Abstract

INTRODUCTION: Lymphocytic Esophagitis (LyE) is an increasingly recognized clinicopathologic entity with an emerging definition. A significant histologic and clinical overlap exists between LyE and reflux esophagitis (RE; however, no specific associations have been elucidated. Previous studies have shown that absence or decrease in the number of granulocytes in esophageal biopsies in patients with LyE have correlated with a different phenotypic presentation from reflux esophagitis, with more patients being predominantly older women with dysphagia. The aim of this study was to help differentiate the two entities based on their clinical characteristics. METHODS: A retrospective chart review was performed of all patients with a biopsy diagnosis of LyE between 2009-2018 at a large tertiary academic institution. Biopsies were then re-categorized into two groups: LyE with few granulocytes (LyE-FG), and reflux esophagitis with increased IELs (RE-IEL). Data regarding socio-epidemiologic, clinical, and histologic findings were collected. RESULTS: A total of 53 biopsies were reviewed (35 RE-IEL, 18 LyE-FG). Most patients were Caucasian- 78% and 75% in RE-IEL and LyE-FG groups, respectively (P = 0.559). Baseline characteristics were similar between the two groups (Table 1). Dysphagia was the most common symptom in both groups with 70.4% in RE-IEL and 75% in LyE-FG groups (P = 0.767) with heartburn being the second most common symptom (63% vs 60%; P = 0.850) respectively. More patients in the LyE-GF group had inflammatory bowel disease (17.6% vs 6.7%); however, this difference was not statistically significant (P = 0.241). A significant number of patients were on proton pump inhibitor (PPI) at the time of diagnosis (75.9% RE-IEL vs 80% LyE-IG; P = 0.756). Patients with RE-IEL were more often smokers (63.3% vs 40%); however, there was no statistical significance (P = 0.138). There was no statistical significance between rates of NSAID or alcohol use between the two groups. Site of biopsy was not statistically significant between the two groups (P = 0.306) with the majority of biopsies taken from the distal esophagus. CONCLUSION: Our study shows the clinical overlap between LyE-FG and RE-IEL. RE and LyE share significant histologic overlap; however, LyE is clinically characterized by dysphagia as the most predominant symptom compared to classic RE, where heartburn and regurgitation are more common.