Lymphocytic Esophagitis: Assessing Risk Factors and Clinical Outcomes
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ORIGINAL ARTICLE
Lymphocytic Esophagitis: Assessing Risk Factors and Clinical Outcomes Himesh B. Zaver1 · Hassan Ghoz2 · Balkishan J. Malviya2 · Bhaumik Brahmbhatt2 · William C. Palmer2 · Brian E. Lacy2 · Kenneth R. DeVault2 · Murli Krishna3 · Yan Bi2 Received: 17 August 2020 / Accepted: 2 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Inflammatory esophageal disorders · Lymphocytic esophagitis · Statins · Aspirin · Epidemiology · Eosinophilic esophagitis 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
* Yan Bi [email protected] 1
Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
2
Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 3222
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