Lymphocytic Esophagitis: Assessing Risk Factors and Clinical Outcomes

Critical Decision Making: Dysphagia

“…Mucosal disorders, for example, eosinophilic esophagitis and lymphocytic esophagitis, some motility disorders, for example, distal esophageal spasm or hypercontractile esophagus, and mechanical causes, for example, esophageal webs/rings may present with more intermittent symptoms depending on what the patient is consuming and/or the size of the bolus. [13][14][15][16] In contrast, dysphagia that is progressive often points toward an evolving process. Mechanical causes of dysphagia such as worsening obstruction from malignancy or stricture tend to cause dysphagia that may worsen over a relatively short time.…”

“…Mucosal disorders, for example, eosinophilic esophagitis and lymphocytic esophagitis, some motility disorders, for example, distal esophageal spasm or hypercontractile esophagus, and mechanical causes, for example, esophageal webs/rings may present with more intermittent symptoms depending on what the patient is consuming and/or the size of the bolus. 13-16…”

Lymphocytic Esophagitis: Diagnosis and Management in the Emergency Department vs Initial Suspicion of Eosinophilic Esophagitis

“…The pathology report was also noteworthy for increased T cells with an admixture of CD4-positive and CD8-positive cells. These findings, markedly in the absence of eosinophils, point toward LyE as a definitive diagnosis which has a better response to treatment historically than does EoE [ 1 ]. In the case of this patient, symptomatic management was deemed to be the best approach.…”

“…When dealing with a seemingly benign presentation in the Emergency Department (ED), it is important to resist the temptation to jump to conclusions and diagnose the “most common cause.” The presentation of dysphagia may be due to a wide range of conditions, including but not limited to paralysis of the swallowing muscles, esophageal web, eosinophilic esophagitis (EoE), peptic stricture, esophageal malignancy, and many types of tumors [ 1 ]. The rare presentations, however, can be most difficult to diagnose and treat due to the sneaking masquerade of more benign and seemingly common causes.…”