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Immune Checkpoint Inhibitor Esophagitis: Clinical and Endoscopic Presentation, Treatment Outcomes, and Complications
Matthew J Townsend1, Afeerah Mumtaz2, Jordan S Sack2,3
1Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Introduction:
We characterized features of immune checkpoint inhibitor (ICI) esophagitis.
Methods:
This was a retrospective cohort of biopsy-confirmed ICI esophagitis.
Results:
Among 11,636 ICI-treated adults, 22 of 312 (7%) undergoing esophagogastroduodenoscopy had ICI esophagitis (0.2% overall). Concomitant luminal ICI toxicities occurred in 19 of 22 (86%); 8 of 22 (36%) had normal esophageal appearance. Most experienced symptom resolution with acid suppression, steroids, and/or biologic therapy; however, 1 developed refractory strictures.
Discussion:
ICI esophagitis is rare, often coexists with other gastrointestinal toxicities, and may seem endoscopically normal, underscoring importance of biopsies. Symptoms are typically treatment-responsive, but histologic inflammation can persist. Rare severe complications highlight needs for recognition and tailored therapy.
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