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Mast Cell Esophagitis: A Novel Entity in Patients with Unexplained Esophageal Symptoms

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Abstract

It is not known whether esophageal mast cells may be a cause of unexplained esophageal symptoms. We aimed to determine the prevalence of esophageal mastocytosis in patients without other underlying causes of symptoms and assess the relationship between symptoms and mast cells. In this retrospective study, we identified adults with esophageal symptoms, a normal endoscopy, normal esophageal biopsies, and no definitive diagnosis during clinical evaluation. We quantified mast cell density (mast cells/mm2) in archived esophageal biopsies using tryptase immunohistochemistry, and compared mast cell levels by clinical features and physiologic testing. In the 87 patients identified (mean age 37, 72% female, 63% white, 92% non-Hispanic), common symptoms were dysphagia (76%), heartburn (71%), and chest pain (25%). Overall, the mean esophageal epithelial mast cell count was 83.0 ± 51.8 mast cells/mm2; 60% of patients had ≥ 60 mast/mm2, and 17% had ≥ 120 masts/mm2. There were no differences in mast cell counts by type of esophageal testing. Mast cell levels did not differ significantly by type of symptoms, atopic status, medications, smoking status, or alcohol use. There were also no major differences in clinical characteristics by mast cell quartiles or thresholds. In conclusion, esophageal mast cell infiltration was common in patients with symptoms unexplained by prior testing, and levels were higher than previously published values for patients with no underlying esophageal condition. Mast cell esophagitis could be a novel cause of unexplained esophageal symptoms in a subset of patients, though it reamins to be determined if such patients benefit from mast cell-targeted treatment.

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Funding

This study was supported by NIH T35 DK007386, and used resources from the UNC Pathology Services Core (PSC) which is supported, in part, by grants from the National Cancer Institute (P30-CA016086), NIEHS (P30ES010126), and NCBT (2015-IDG-1007).

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, CB#7080, Bioinformatics Building, 130 Mason Farm Rd.,UNC-CH, Chapel Hill, NC, 27599-7080, USA

    Adolfo A. Ocampo & Evan S. Dellon

  2. Inform Diagnostics, Irving, TX, USA

    Robert M. Genta

  3. Departments of Pathology and Medicine (Gastroenterology), Baylor College of Medicine, Houston, TX, USA

    Robert M. Genta

  4. Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease,, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Evan S. Dellon

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  1. Adolfo A. Ocampo
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Contributions

AAO: Study design, data collection and interpretation, manuscript drafting, critical revision. RMG: Data interpretation, critical revision. ESD: Project conception, study design, data collection, data analysis/interpretation, manuscript drafting, critical revision

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Correspondence to Evan S. Dellon.

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Ocampo, A.A., Genta, R.M. & Dellon, E.S. Mast Cell Esophagitis: A Novel Entity in Patients with Unexplained Esophageal Symptoms. Dysphagia (2023). https://doi.org/10.1007/s00455-023-10616-8

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