Lymphocytic esophagitis: Still an enigma a decade later

Abstract

Lymphocytic esophagitis (LE) is a clinicopathologic entity first described by Rubio et al in 2006. It is defined as peripapillary intraepithelial lymphocytosis with spongiosis and few or no granulocytes on esophageal biopsy. This definition is not widely accepted and the number of lymphocytes needed to make the diagnosis varied in different studies. Multiple studies have described potential clinical associations and risk factors for LE, such as old age, female gender and smoking history. This entity was reported in inflammatory bowel disease in the pediatric population but not in adults. Other associations include gastroesophageal reflux disease and primary esophageal motility disorders. The most common symptom is dysphagia, with a normal appearing esophagus on endoscopy, though esophageal rings, webs, nodularities, furrows and strictures have been described. Multiple treatment modalities have been used such as proton pump inhibitors and topical steroids. Esophageal dilation seems to be therapeutic when dysphagia is present along with esophageal narrowing secondary to webs, rings or strictures. The natural history of the disease remains unclear and needs to be better delineated. Overall, lymphocytic esophagitis seems to have a chronic and benign course, except for two cases of esophageal perforation in the literature, thought to be secondary to this entity.

Lymphocytic esophagitis: an update on histologic diagnosis, endoscopic findings, and natural history

“…Both patients were treated conservatively and recovered well. There have been no reports of malignant transformation in this setting …”

Lymphocytic esophagitis: An Australian (Queensland) case series of a newly recognized mimic of eosinophilic esophagitis

“…There was no relationship with BMI or use of NSAID or PPI. Thus, to date, LoE remains a “disease” with no established definition or clinical associations …”

“…In a limited number of patients who had follow‐up biopsies, histological normalization was observed in 9 of 22 cases, indicating that histological changes can potentially normalize in about half the patients, however; the number of patients in this study was small . Some authors found that the risk factors for LoE were elderly females (63%) and history of current or past smoking (55%), while we did not find the same (60% of our patients were male), possibly due to the high number of male (eight males, five females) pediatric patients in our series. There was no relationship with BMI or use of NSAID or PPI.…”

Lymphocytic Esophagitis: A Rare Disease on the Rise

“…The most frequent endoscopic findings include esophageal rings, esophagitis, and esophageal strictures. Perforation is an uncommon complication of lymphocytic esophagitis and has only been documented in two other cases in the literature [ 2 ].…”