163 Reevaluating Esophageal Biopsies for Lymphocytic Esophagitis: Diagnostic Implications and Clinical Correlates

Introduction/Objective Lymphocytic esophagitis (LyE) is an emerging clinicopathologic entity and is often underdiagnosed. Additionally, LyE has been linked to various immunological disorders. This study aimed to re-evaluate esophageal biopsies applying specific microscopic criteria to reconsider LyE diagnosis and explore associated co-morbidities. Methods/Case Report 101 esophageal biopsies (proximal/mid) from 2022-2025 with prior diagnoses of non-specific chronic inflammation and/or mild reactive changes were retrospectively reviewed. CD3 immunostaining was performed in selected cases. Diagnostic criteria included ≥50 intraepithelial lymphocytes/high power field (IELs/HPF), epithelial damage and absence of granulocytes. Medical records including age, sex and co-morbidities were collected. Exclusion parameters involved biopsies from lower esophagus, history of gastric reflux and presence of granulocytes. 5 prior LyE cases were included to enhance clinical correlation. Results 26 of 101 cases (25.7%) were newly identified as LyE. The LyE group had a higher median age (64 vs 53 years, p = 0.088) and similar female predominance (58.1% vs 58.7%, p = 1). Immune-related conditions were frequently identified in the LyE group (32.3% vs 13.3%, p = 0.0463). Conclusion Overall, this study reveals underreporting of LyE and its association with immune-related conditions. Notable conditions in LyE vs non-LyE included fibromyalgia (9.7% vs 1.3%), scleroderma (9.7% vs 0%), Crohn’s Disease (3.2% vs 0%), and HLA-B27 association (6.5% vs 0%).