A systematic review of therapeutic options for lymphocytic esophagitis

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.

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.

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.

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.