Lymphocytic Esophagitis

Abstract

Background Despite being found with increasing frequency on esophageal biopsies, the clinical significance of lymphocytic esophagitis (LE) remains poorly understood. Goals The primary aim of our study was to characterize the clinical presentation and natural history of LE among adult patients. Study We retrospectively reviewed records for all 81 adult patients at the University of Michigan Medical Center who had a histopathological diagnosis of LE between January 1998 and November 2009. Patient demographics, clinical history, laboratory data, and imaging results from the time of diagnosis were obtained through review of computerized medical records. A telephone survey was conducted to collect natural history data. Results The number of LE diagnoses increased over time, with 81.5% (n=66) of patients being diagnosed in the last three years. The most frequent symptoms at the time of presentation were dysphagia (n=54), chest/abdominal pain (n=36), and heartburn (n=38). The majority (58.6%) of patients reported improvement in their initial gastrointestinal symptoms – most commonly associated with initiation of a proton pump inhibitor. Upon follow-up, most patients reported a good quality of life and satisfaction with their current health status. Conclusions Lymphocytic esophagitis is a new clinical entity with an increasing incidence. LE appears to have a benign natural history, with most patients reporting an improvement in symptoms and satisfaction with their health-related quality of life. Prospective studies are needed to better characterize the natural history and potential treatments for this clinical entity.

Lymphocytic Esophagitis: An Emerging Clinicopathologic Disease Associated with Dysphagia

“…From a symptom standpoint, our data is consistent with several other studies that have also noted dysphagia to be the most common symptom at presentation of LyE [2,16]. Relatively few of our patients complained of other upper GI symptoms such as heartburn, abdominal pain, chest pain, nausea/vomiting, or odynophagia, which is similar to other studies [2,3,5,16,17].…”

“…Relatively few of our patients complained of other upper GI symptoms such as heartburn, abdominal pain, chest pain, nausea/vomiting, or odynophagia, which is similar to other studies [2,3,5,16,17]. However, the possible association between smoking and LyE has not been previously observed.…”

“…Subsequently, as recognition of this histopathologic condition has become more widespread, there has also been some controversy related to LyE as studies have both questioned prior findings and attempted to better characterize this new entity [2–8]. …”

Lymphocytic esophagitis: Report of three cases and review of the literature

“…This was supported by Haque et al[5] who reviewed biopsy specimens from 129252 patients and found symptoms of GERD were significantly less frequent (18%) in patients with LyE compared to patients with normal esophageal biopsies (37%). This finding however was contradicted by Cohen et al[7] who reported GERD to be the most common association (49%) in their study cohort of 81 patients with LyE. In an assessment of the histologic importance of lymphocytes in EoE and reflux esophagitis, there were similar number of patient with GERD and intraepithelial lymphocytosis[9] prompting some to postulate that perhaps LyE is an extreme spectrum of GERD[10].…”

“…Cohen et al[7] in their study cohort of 81 patients found the presentation of LyE was highest in females in the 6 th deciles of life and most commonly presenting with symptoms of dysphagia, chest discomfort, heartburn, and less frequently food impaction. This was corroborated in a recent study by Xue et al[8].…”