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Lymphocytic Esophagitis: Assessing Risk Factors and Clinical Outcomes

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Abstract

Background

Lymphocytic esophagitis is a rare esophageal condition. Our knowledge of potential risk factors and treatment outcomes of lymphocytic esophagitis is limited.

Aim

To investigate potential risk factors associated with the development of lymphocytic esophagitis and compare clinical characteristics and treatment outcomes of patients diagnosed with lymphocytic esophagitis to patients diagnosed with eosinophilic esophagitis.

Methods

This is a multicenter retrospective study. Lymphocytic esophagitis patients were identified based on pathology results between 1997 and 2019. Control groups consisted of patients with normal esophageal biopsies and patients diagnosed with eosinophilic esophagitis. Thirteen potential risk factors for lymphocytic esophagitis were analyzed using univariate and multivariate models including IBD, achalasia, hyperlipidemia, hypothyroidism, celiac sprue, CVID, H. pylori, thymoma, aspirin, opioids, ACE-I, metformin, and statin use. Comparative statistics were performed.

Results

Ninety-four adult patients with lymphocytic esophagitis, 344 with eosinophilic esophagitis, and 5202 control patients with normal esophageal biopsies were analyzed. Age older than 60 [adjusted odd ratio (AOR) 1.03, 95% CI 1.02–1.05, p = 0.001], aspirin use (2.7, 95% CI 1.4–4.9, p = 0.001), statin use (2.2, 95% CI 1.2–4.2, p = 0.01), or a diagnosis of achalasia (2.4, 95% 1.08–5.67, p = 0.03) were associated with lymphocytic esophagitis. Compared to eosinophilic esophagitis, lymphocytic esophagitis patients were more likely to respond to medical treatment (95% CI 2.54–12.8, p = 0.0001).

Conclusions

Our data suggests that lymphocytic esophagitis is more likely to be found in older female patients and is significantly associated with achalasia, statin, and aspirin use. Compared to eosinophilic esophagitis, lymphocytic esophagitis is more likely to respond to treatment with medical therapy.

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Abbreviations

LE:

Lymphocytic esophagitis

EoE:

Eosinophilic esophagitis

hpf:

High-power field

GERD:

Gastroesophageal reflux disease

IBD:

Inflammatory bowel disease

CVID:

Common variable immunodeficiency disorder

PPI:

Proton pump inhibitors

ACE:

Advanced cohort explorer

EGD:

Esophagogastroduodenoscopy

ACE-I:

Angiotensin-converting enzyme inhibitors

NSAID:

Nonsteroidal anti-inflammatory

STC:

Swallowed topical steroids

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA

    Himesh B. Zaver

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Hassan Ghoz, Balkishan J. Malviya, Bhaumik Brahmbhatt, William C. Palmer, Brian E. Lacy, Kenneth R. DeVault & Yan Bi

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA

    Murli Krishna

Authors
  1. Himesh B. Zaver
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  2. Hassan Ghoz
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  3. Balkishan J. Malviya
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  4. Bhaumik Brahmbhatt
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  5. William C. Palmer
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  6. Brian E. Lacy
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  7. Kenneth R. DeVault
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  8. Murli Krishna
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  9. Yan Bi
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Contributions

H.Z., G.H., B.M., B.B., W.C., B.L., K.D., M.K., and Y.B. contributed to multiple aspects of this study including but not limited to the planning and/or conducting of this study, collecting and/or interpreting data, and/or drafting the manuscript. All authors approve the final draft submitted.

Corresponding author

Correspondence to Yan Bi.

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All authors have no conflicts of interest to disclose.

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Zaver, H.B., Ghoz, H., Malviya, B.J. et al. Lymphocytic Esophagitis: Assessing Risk Factors and Clinical Outcomes. Dig Dis Sci 66, 3976–3984 (2021). https://doi.org/10.1007/s10620-020-06706-4

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  • DOI: https://doi.org/10.1007/s10620-020-06706-4

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