PART 2: UNUSUAL CAUSES OF ESOPHAGITIS: CLINICAL EVALUATION/ENDOSCOPIC DIAGNOSIS AND PATHOLOGIC CORRELATES

Society: AGA

This symposium aims to highlight the immense (but sometimes underrated) importance of clinico-pathologic correlation for optimal patient management. The gastroenterologist would present clinical evaluation/endoscopic findings and the gastrointestinal (GI) pathologist would present pathologic correlates on three different topics to emphasize that working together and optimal communication between clinician and GI pathologist can improve patient management. The first topic would cover iatrogenic GI tract injury by discussing some relatively recently described drugs causing GI tract changes. Some drugs (such as doxycycline) exhibit relatively characteristic histologic features, while there are others (such as sartans) that can show wide histomorphologic overlap with many other major disease entities. Many patients have significant but non-specific symptoms, and hence high index of suspicion is crucial. An optimal communication can lead to pinpointing of the offending drug as the etiology in these cases. The second topic is getting progressively more important in this era of immunotherapy. The clinician will discuss their perspective and indication for biopsies in patients experiencing immune related adverse events secondary to immunotherapy, and the pathologist would present their assessment of varying histopathologic injury patterns that can show wide overlap with a lot of other etiologies and can be easily misdiagnosed, in the absence of clinical history. In the third topic, we intend to go beyond the commonly recognized patterns of esophagitis (such as reflux disease or eosinophilic esophagitis ) and discuss the clinical and pathologic correlates of some unusual forms of esophagitis, , such as lymphocytic esophagitis, sloughing esophagitis, amongst others.