A141 TREATMENT OPTIONS FOR LYMPHOCYTIC ESOPHAGITIS: A SYSTEMATIC REVIEW OF CASE REPORTS AND CASE SERIES
Bibliographic record
Abstract
Abstract Background Lymphocytic esophagitis (LyE) is a novel rare disorder characterized by intraepithelial lymphocytic infiltration of the esophagus in a peripapillary distribution without granulocytes, first described by Rubio et al. in 2006. No systematic reviews or randomized controlled trials have been published to date on the treatment options for LyE. Aims To describe the current state of evidence published to date for the treatment of lymphocytic esophagitis. Methods We performed a systematic review according to PRISMA guidelines, searching MEDLINE, Embase, Scopus, and Web of Science. Descriptive statistics were performed after extracting data on the study design, patient characteristics, treatment modalities, and outcomes (symptomatic, endoscopic, and histologic). The absence of randomized controlled trials and heterogeneity in outcome measures precluded the ability to perform a formal meta-analysis. Results A total of 39 articles (36 case reports, 3 case series) from 2012-2024 were selected for analysis. Proton pump inhibitors (PPIs) were the most common initial therapy used in 73.2% of patients (60/82), followed by topical steroids in 26.8% (22/82). A greater proportion of patients experienced a symptomatic, histologic and endoscopic response from initial use of topical steroids as monotherapy or part of PPI/Steroids combination therapy compared to PPIs alone. Histologic response was highest in the steroid monotherapy group (Table 1). Symptomatic recurrence was more common after initial use of topical steroids (as monotherapy or part of combination therapy) compared to PPIs alone (Table 1) but the samples sizes were very small. Initial endoscopic dilation improved symptoms in 90% (9/10) of patients and 66.7% (4/6) had successful stricture resolution, but 25% of patients experienced symptomatic recurrence. Other therapies for LyE included Vedolizumab, Botox injection, Sucralfate and Tacrolimus. The average follow-up duration was 8.98 months. Conclusions For patients with histologically confirmed LyE, both PPIs and topical steroids are viable options for symptomatic relief, with topical steroids showing higher symptomatic and histologic improvement. Balloon dilation may alleviate dysphagia in cases of obvious strictures. Given the limited available data, further research, including randomized controlled trials, is necessary to better define optimal treatment targets (histologic vs. symptomatic outcomes) and to formally compare treatment efficacies. Table 1: Initial treatment response and symptomatic recurrence Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.005 |
| Bibliometrics | 0.012 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".