Prevalence and Characteristics of Lymphocytic Esophagitis in Barrett's Esophagus
Kevin L Golden, Carissa Sanchez, David Cowan, Brian Reid, Patricia Blount, Robert Odze, Amitabh Srivastava. Brigham and Women's Hospital, Boston, MA; Fred Hutchinson Cancer Center and University of Washington, Seattle, WA
Background: Lymphocytic esophagitis (LE) is a recently recognized disorder in which the pathogenesis, risk factors and clinical significance remain poorly understood. Lymphocytic esophagitis has been reported to be causally associated with Crohn's disease, celiac disease, several drugs, and possibly gastroesophageal reflux disease, but it has never been systematically evaluated in the setting of Barrett's esophagus (BE). The aim of this study was to evaluate the prevalence, and the clinical and pathologic features, of LE in BE and to determine its association with aneuploidy, as determined by flow cytometry on frozen samples of tissue.
Design: Mucosal biopsies of squamous epithelium located proximal to BE were evaluated from 184 consecutive BE patients enrolled in a long term prospective surveillance program. All biopsies were reviewed for the presence, grade (low or high, based on the degree of lymphocytosis, 11-30 vs. >30 lymphocytes/HPF), and location of LE, based on previously reported criteria (peripapillary lymphocytosis, spongiosis, absence of other inflammatory cells). The data was correlated with clinical, endoscopic, and pathologic features, such as length of BE, dysplasia type and grade, and aneuploidy, and compared between patients with or without LE, and between LE patients with low or high-grade lymphocytosis.
Results: Overall, 23 of 184 patients (12.5%) met criteria for LE. 12 (6.5%) were considered low-grade and 11 (6%) were high-grade (>30 lymphocytes per HPF). Patients with LE (either low or high-grade) had a significantly higher incidence of dysplasia (p=0.02), but did not differ from patients without LE with regard to any of the other clinical, endoscopic, or pathologic variables analyzed, including the presence or absence of aneuploidy. No differences were noted between patients with low versus high-grade LE. 9 of 23 patients had follow-up biopsies, obtained 1-4 years later, available for review. Of these, 4 showed persistent LE of equal grade, whereas 5 had reverted back to normal.
Conclusions: In this BE cohort, the prevalence rate of LE was 12.5%. The reasons for the observed association with dysplasia are uncertain and need to be explored in future studies. In some patients, LE is temporary, reverting to normal without any additional or specific form of treatment.
Monday, March 4, 2013 1:00 PM
Poster Session II # 111, Monday Afternoon