Lichenoid Esophagitis: A Clinicopathological Comparison with Lymphocytic and Eosinophilic Esophagitis.

Background and aims: Lichenoid esophagitis (LichE) is rarely encountered by gastrointestinal endoscopists. Using a large nationwide database of clinicopathological records, the demographic and clinical characteristics of patients with LichE were compared to patients with lymphocytic esophagitis (LyE) and eosinophilic esophagitis (EoE).

Methods: In a case-control study, cases with a diagnosis of LichE, LyE, or EoE were compared to a control population of all patients without these 3 conditions. In addition to histopathology, patients' demographics, clinical presentation, and gastrointestinal comorbidities were considered. Statistical significance was assessed using odds ratios (OR) and 95% confidence intervals (95%CI).

Results: Among 967,773 unique patients with esophageal biopsies, LichE was found in 511 (0.05%), LyE in 1,786 (0.18%), EoE in 56,474 (5.84%), and none of these 3 diagnoses in a control population of 909,002 patients. LichE patients were significantly older, and EoE patients were significantly younger than the control population (p<0.0001). LichE and LyE significantly prevailed in females (OR=1.69; 95%CI: 1.40-2.04 and 1.34; 1.22-1.47, respectively). EoE was significantly less common in females (OR=0.49; 95%CI: 0.48-0.49). All 3 types of esophagitis were significantly less common among Hispanics, with their respective ORs of 0.70 (95%CI: 0.50-0.98), 0.83 (95%CI: 0.70-0.98), and 0.55 (95%CI: 0.53-0.57). EoE was also less common in persons of East and South Asian ancestry, with respective ORs of 0.52 (95%CI: 0.47-0.56) and 0.66 (95%CI: 0.56-0.76).

Conclusions: Increasing clinical awareness of LichE may enhance its clinico-pathological recognition, clarify its natural history, and ultimately lead to more effective clinical management.