S4325 Bravo pH Monitoring in Lymphocytic Esophagitis

Introduction: Lymphocytic esophagitis (LyE) is a chronic inflammatory esophageal condition marked by high numbers of intraepithelial lymphocytes. Reflux esophagitis may increase intraepithelial lymphocytes, potentially contributing to LyE, though data for this is limited. Bravo pH monitoring may offer insight into the pathogenesis of acid reflux in LyE, aiding diagnosis and treatment. We present 3 patients with biopsy proven LyE who underwent Bravo pH testing. Case Description/Methods: A 64-year-old woman, previous smoker, presented with chronic dysphagia on esomeprazole. Esophagogastroduodenoscopy (EGD) showed normal mucosa & hiatal hernia. Esophageal biopsies showed LyE. Due to persistent dysphagia on proton pump inhibitors, she underwent a 48-hr Bravo pH study which found a Day 2 total acid exposure time (AET) of 7.7%, DeMeester score of 28.3 (normal <14.95) with 19 reflux events detected. She was switched to pantoprazole with symptom improvement over the following months. Repeat EGD biopsies showed improvement in LyE severity. A 62-year-old woman, non-smoker, with hx of heartburn & asthma presented with nausea and worsening chronic solid food dysphagia of 26 years. EGD showed multiple gastric polyps, nodular duodenal mucosa & normal esophagus with distal esophageal biopsies positive for mild LyE. Due to persistent dysphagia despite dexlansoprazole and famotidine therapy, she underwent 48-hr Bravo pH study which showed an AET of 6% and DeMeester score of 27.2. With 8 weeks of twice a day proton pump inhibitors she had partial improvement in dysphagia and heartburn. A 54-year-old woman with heartburn, prior H. pylori, and smoking presented with weight loss, decreased appetite, and postprandial discomfort. EGD showed normal esophagus, stomach, and duodenum. Esophageal biopsies were positive for LyE. Despite pantoprazole therapy, symptoms persisted & 48-hr Bravo pH testing showed AET of 6%, 42 reflux events and DeMeester score of 27.6. After switching to high-dose omeprazole her heartburn soon resolved. Follow up EGD & biopsy showed normal esophageal mucosa without LyE, suggesting both symptomatic and histologic remission. Discussion: All 3 patients with LyE on EGD had positive Bravo pH studies consistent with pathologic reflux and had improvement with reflux control. Bravo pH monitoring may offer insight into the role of reflux in LyE and help guide treatment. Larger studies are needed to obtain well-defined data on the current treatment protocol and long-term outcomes of LyE.