Post-ablation lymphocytic esophagitis in Barrett esophagus with high grade dysplasia or intramucosal carcinoma

Abstract

In patients who have undergone ablation therapy for treatment of Barrett's esophagus with dysplasia, histologic features of eosinophilic esophagitis, but not lymphocytic esophagitis, have been described. We evaluated for histologic evidence of eosinophilic esophagitis and lymphocytic esophagitis and correlated with endoscopic findings in this population. A single-institution Barrett's esophagus registry was searched for patients who had received radiofrequency ablation, cryotherapy, or both for treatment of Barrett's esophagus with dysplasia. Clinical and endoscopic data were collected and biopsies were reviewed for inflammation and reactive changes at three time points: pre-intervention, first surveillance after ablation therapy, and most recent surveillance. Of the 173 patients initially identified, 102 met the inclusion criteria. Intraepithelial eosinophils were increased at first surveillance (60%, P = 0.096) and last surveillance (69%, P = 0.048) compared with pre-intervention (50%), although histologic evidence of post-ablation eosinophilic esophagitis was not significant. Prevalence of lymphocytic esophagitis was significantly higher at first surveillance (17%, P = 0.02) and at last surveillance (43%, Po 0.001), compared with pre-intervention (7%). Smoking, hyperlipidemia, and cryotherapy were identified as independent risk factors for developing histologic lymphocytic esophagitis. This is the first report that histologic evidence of lymphocytic esophagitis increased over time in patients undergoing ablation for Barrett's esophagus with dysplasia. Though the pathophysiology of lymphocytic esophagitis remains unknown, patients in our study with a history of smoking, hyperlipidemia, or cryotherapy were more likely to develop post-ablation lymphocytic esophagitis.

Lymphocytic esophagitis: Still an enigma a decade later

“…To the best of our knowledge, only three case reports in the English literature described cases of LE outside the United States, including Japan[ 19 ], Portugal[ 20 ] and Australia[ 21 ]. In contrast to the findings of Rubio et al[ 1 ], it is becoming evident that LE seems to affect older women to a larger extent, in their sixth decade[ 12 , 14 , 17 , 18 ], in contrast to eosinophilic esophagitis (EoE) seen in younger men. Smoking was also found to be associated with LE in multiple retrospective studies[ 14 , 17 ].…”

“…A better immunophenotypic characterization of LE is hence needed for a superior definition. Another aspect of deficiency in the definition of LE is reflected in the various studies performed with different cut-offs used to demarcate an increased IEL count, ranging between ≥ 10 IEL/HPF[ 14 ] and ≥ 50 IEL/HPF[ 15 , 16 ] with a cut off of ≥ 20 IEL/HPF being commonly used[ 17 , 18 ]. Moreover, the acceptable number of a " few granulocytes " needs to be better defined, as granulocytic inflammation is typically seen in GERD.…”

Lymphocytic esophagitis: an update on histologic diagnosis, endoscopic findings, and natural history

“…Kissiedu et al . reported a higher rate of intraepithelial lymphocytosis in postablation biopsies compared with preintervention samples among 102 patients with Barrett esophagus and dysplasia …”

“…15 Kissiedu et al reported a higher rate of intraepithelial lymphocytosis in postablation biopsies compared with preintervention samples among 102 patients with Barrett esophagus and dysplasia. 16 Once the abovementioned disorders are excluded, lymphocytic esophagitis may be associated with several important conditions. It is clearly a manifestation of Crohn's disease among pediatric patients, but there is no established association between Crohn's disease or celiac disease and lymphocytic esophagitis in adult patients.…”

Lymphocytic Esophagitis in Nonachalasia Primary Esophageal Motility Disorders

“…(2, 3) Previous studies report associations of LE with achalasia, Crohn’s disease in children, post-ablation status in Barrett esophagus, common variable immunodeficiency, lichen planus and some other dermatological disorders. (3, 6–11) However, in the majority of adult patients with LE clinical correlates have not been established. (2–4) We have recently proposed a link between LE and esophageal dismotility patterns.…”