A systematic review of therapeutic options for lymphocytic esophagitis
Bibliographic record
Abstract
BACKGROUND: Lymphocytic esophagitis (LyE) is a novel rare esophageal disorder characterized by intraepithelial lymphocytic infiltration of the esophagus in a peripapillary distribution, without the involvement of granulocytes. The optimal treatment strategy for this condition remains uncertain. We aimed to synthesize the current evidence for the treatment of lymphocytic esophagitis. METHODS: We performed a systematic review according to PRISMA guidelines, searching MEDLINE, Embase, and Google Scholar. Studies with non-primary data or insufficient treatment data were excluded. Descriptive statistics were performed on patient demographics and treatment outcomes. RESULTS: Thirty nine articles from 2012-2024 were included (154 patients total). Proton pump inhibitors (PPIs) were the most common initial therapy for LyE (n = 65), followed by topical steroids (n = 23). A greater proportion of patients experienced a symptomatic, endoscopic, and histologic response from the initial use of topical steroids as monotherapy or part of combination therapy (with PPIs) compared to PPIs alone. Symptomatic recurrence was more common after initial use of topical steroids compared to PPIs. Balloon dilation was effective in relieving symptomatic esophageal dysphagia. Other therapies included biologics, endoscopic botulinum injections, sucralfate, and tacrolimus. The average follow-up duration was 8.98 months. CONCLUSIONS: For patients with LyE, topical steroids seem to provide greater symptomatic and histologic benefit compared to PPIs, although recurrence is more common. For patients not already on acid suppression therapy, PPIs may still be a reasonable first-line option, especially when prioritizing safety. Further prospective studies are needed to formally assess the comparative safety and efficacy of the various treatment modalities, including novel immunosuppressive therapies.
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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 | 0.005 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.008 |
| Bibliometrics | 0.012 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
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".