Lymphocyte-Predominant Esophagitis Rarely Improves With Proton Pump Inhibitor Therapy

Abstract

Lymphocyte-predominant esophagitis (LPE) refines the diagnosis of lymphocytic esophagitis using the criteria of >20 intraepithelial lymphocytes/HPF and excluding those with known causes of secondary lymphocytosis (gastroesophageal reflux disease and motility disorders). The primary aim of this study was to assess response of LPE to treatment. From 2008 to 2019, 62 LPE patients were identified. Demographics, symptoms, endoscopic findings, histology, and treatment responses were reviewed. Only 24% of LPE patients treated with proton pump inhibitors (PPI) reported symptom improvement and only 17% had endoscopic improvement. All LPE patients with autoimmune disease treated with steroids had symptom improvement and resolution of LPE. In this retrospective series LPE was frequently associated with autoimmune disease, and had limited response to PPIs but frequent response to steroids and/or treatment of the underlying disease.