Clinical, endoscopic, and histologic characteristics of lymphocytic esophagitis: a systematic review

Habbal, Zuheir; Scaffidi, Michael A.; Rumman, Amir; Khan, Rishad; Ramaj, M; Al‐Mazroui, Ahmed; Abunassar, M J; Jeyalingam, Thurarshen; Shetty, Akshay; Kandel, Gabor; Streutker, Catherine

doi:10.1007/s10388-018-0649-1

Cited by 16 publications

(9 citation statements)

References 65 publications

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“…The involvement of lymphocytes in the pathogenesis of allergic diseases and lymphocytic esophagitis may indicate a link between these diseases; however, further research is required to confirm this hypothesis. Interestingly, in our patient, we also observed the coexistence of allergic skin eczema in the context of a nickel allergy and lymphocytic esophagitis, in addition to allergic rhinitis and asthma [12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 97%

“…TCR receptors each have different specificity, and Th1 cell profiles support a cellular immune response, whereas the Th2 population plays a role in the modulation of allergic inflammation. Thus, T cells appear to be the most important cells in both allergic and lymphocytic esophagitis [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, published reports are not consistent. Habbal et al conducted a systematic review of 14 studies involving 379 patients and found that the most common associations were motility disorders (12.0%), smoking tobacco (12.7%), alcohol consumption (11.4%), hypothyroidism (9.4%), allergies (7.4%), and asthma (5.4%) [ 12 ]. In the study conducted by Purdy et al, allergies were reported in 33% of patients with LyE.…”

Section: Discussionmentioning

confidence: 99%

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A case of lymphocytic esophagitis in a woman with multiple allergies

Wojas

Żalikowska-Gardocka

Krzych‐Fałta

et al. 2021

Allergy Asthma Clin Immunol

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Background Lymphocytic esophagitis is a newly recognized entity of unknown origin. Dysphagia is defined as difficulty swallowing and represents a common symptom in the general population with a prevalence of approximately 20%. Chronic inflammation of the esophageal wall may manifest itself clinically and endoscopically, mimicking inflammation of another origin. However, little is known about the pathogenesis of the disease, as patients are seldom suspected and rarely diagnosed with lymphocytic esophagitis. Case presentation Here, we present a rare case of lymphocytic esophagitis in a patient with multiple allergies and suspected eosinophilic esophagitis. A 28-year-old woman with polyvalent sensitization to food and inhalant allergens presented with intermittent dysphagia, a sensation of a foreign body in the throat, itchiness of the oral cavity after ingesting certain foods, heartburn, and prolonged chewing time. A skin prick test showed positive results for birch-tree, alder, hazel, and rye pollen, as well as house dust mites. Apart from obesity (BMI 30 kg/m2), multiple pustules and excoriations on the skin, her physical examination was insignificant. Esophagogastroduodenoscopy (EGD) was performed revealing full-length but discrete trachealization of the esophagus. A barium swallow test showed slowing of esophageal peristalsis in the recumbent position. No esophageal pathology was observed. A histopathological analysis of mucosal samples revealed slight hyperplasia of the basal layer of the esophagus, and the stomach showed changes typical of chronic gastritis. Conclusions In summary, this clinical case illustrates that lymphocytic esophagitis, as a newly recognized entity, should be considered in the differential diagnosis of chronic dysphagia. Additionally, when treating allergic patients, clinicians should be aware that lymphocytic esophagitis, distinct from eosinophilic esophagitis, should be considered in the diagnosis of patients with atopy and upper gastrointestinal symptoms.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A case of lymphocytic esophagitis in a woman with multiple allergies

Wojas

Żalikowska-Gardocka

Krzych‐Fałta

et al. 2021

Allergy Asthma Clin Immunol

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“…Patients often complain of heartburn, dyspepsia, abdominal pain, nausea, and vomiting but dysphagia seems to be present in approximately 57% of the patients. Food impaction can also occur [5].…”

Section: Discussionmentioning

confidence: 99%

A New Differential Diagnosis of Dysphagia: A Case Report of Lymphocytic Esophagitis

Resende¹,

Ferrão²,

Melo³

et al. 2021

Cureus

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Lymphocytic esophagitis is a rare but increasingly recognized cause of chronic esophagitis. The pathogenesis, prognosis, and treatment are undefined. We report the diagnostic workup of an unusual cause of dysphagia. We present a case report of a 71-year-old female who presented with dysphagia for solid foods. The endoscopic appearance showed stenosis at the cricopharyngeus and trachealization of the proximal esophagus. Biopsies were taken to exclude eosinophilic esophagitis. The pathology showed lymphocytic infiltrate with peripapillary distribution with no granulocytes and spongiosis suggestive of lymphocytic esophagitis. Esomeprazol was started with symptomatic improvement. The symptoms and endoscopic appearance of lymphocytic esophagitis may be indistinguishable from other forms of chronic esophagitis. A high index of suspicion and mucosal sampling are essential to establish the diagnosis. Lymphocytic esophagitis seems to be a chronic and benign form of esophagitis. It should be included in the differential diagnosis of dysphagia. Further research and case reporting are essential to better define its pathogenesis, prognosis, and treatment.

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“…EoE can present with typical GERD symptoms, although the clinical clue in adults is a history of intermittent dysphagia or food impaction; oesophageal biopsies are required to definitely rule out this possibility ( Figure 3) [51]. Lymphocytic oesophagitis is a rare disease but in about 28% of patients GERD symptoms are present [52] (Figure 3). Histopathological changes are well described in GERD (Figure 3), but the lack of accuracy (specificity 78%, sensitivity 30%) and expense limits their use as a diagnostic tool in GERD [53].…”

Section: Role Of Upper Endoscopy and Biopsymentioning

confidence: 99%

Optimal management of severe symptomatic gastroesophageal reflux disease

Talley

Irani

2020

J. Intern. Med.

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Gastroesophageal reflux disease (GERD) is a common disorder, and empirical proton pump inhibitor (PPI) treatment is often the first step of management; however, up to 40% of patients remain symptomatic despite PPI treatment. Refractory reflux refers to continued symptoms despite an adequate trial of PPI, and management remains challenging. The differential diagnosis is important; other oesophageal (e.g. eosinophilic oesophagitis) and gastroduodenal disorders (e.g. functional dyspepsia) should be ruled out, as this changes management. A combination of clinical assessment, endoscopic evaluation and in selected cases oesophageal function testing can help characterize patients with refractory reflux symptoms into oesophageal phenotypes so appropriate therapy can be more optimally targeted. Medical options then may include adding a H2 receptor antagonist, alginates, baclofen or antidepressant therapy, and there is emerging evidence for bile acid sequestrants and diaphragmatic breathing. The demonstration of a temporal association of symptoms with reflux events on pH‐impedance testing (reflux hypersensitivity) serves to focus the management on modulating oesophageal perception and reducing the reflux burden, or identifies those with no obvious pathophysiologic abnormalities (functional heartburn). Anti‐reflux surgery based on randomized controlled trial evidence has a role in reflux hypersensitivity or continued pathological acid reflux despite PPI in carefully considered, fully worked up cases that have failed medical therapy; approximately two of three cases will respond but there is a small risk of complications. In patients with persistent volume reflux despite medical therapy, given the lack of alternatives, anti‐reflux surgery is a consideration. Promising newer approaches include endoscopic techniques. This review aims to summarize current diagnostic approaches and critically evaluates the evidence for the efficacy of available treatments.

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Clinical, endoscopic, and histologic characteristics of lymphocytic esophagitis: a systematic review

Cited by 16 publications

References 65 publications

A case of lymphocytic esophagitis in a woman with multiple allergies

A case of lymphocytic esophagitis in a woman with multiple allergies

A New Differential Diagnosis of Dysphagia: A Case Report of Lymphocytic Esophagitis

Optimal management of severe symptomatic gastroesophageal reflux disease

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