How to Approach Lymphocytic Esophagitis

Abstract

Studies have suggested that LE may be related to eosinophilic esophagitis (EoE) or a manifestation of gastroesophageal reflux disease (GERD). There is an association between LE and Crohn's disease in children, but not in adults. Patients with LE frequently report symptoms of dysphagia and GERD. Treatment options for LE are limited and involve symptom management similar to treatment of EoE or GERD, including proton pump inhibitors (PPI), swallowed topical steroids, and endoscopic dilation. With no formal definition and a variety of clinical presentations and endoscopic findings, diagnosis and management of symptomatic LE patients is challenging for clinicians.

The microscopic anatomy of the esophagus including the individual layers, specialized tissues, and unique components and their responses to injury

“…Eosinophilic esophagitis, GERD, parasitic infections, Crohn's disease, drug hypersensitivity, hypereosinophilic syndrome, celiac disease, vasculitis, and collagen vascular disorders are commonly associated with increased intraepithelial eosinophils . Lymphocytes tend to be a predominant component of inflammatory cells in chronic GERD, drugs‐/medications‐related injury, Crohn's disease (especially children), achalasia/motility disorders, autoimmune diseases, immunodeficiency (e.g., HIV and CVID), celiac disease, as well as dermatologic conditions, among others …”

“…14 Lymphocytes tend to be a predominant component of inflammatory cells in chronic GERD, drugs-/medications-related injury, Crohn's disease (especially children), achalasia/motility disorders, autoimmune diseases, immunodeficiency (e.g., HIV and CVID), celiac disease, as well as dermatologic conditions, among others. 15…”

Lymphocytic Esophagitis: A Rare Disease on the Rise

“…The rise in the diagnosis of lymphocytic esophagitis could be due to the increase in endoscopic procedures and the availability of dedicated pathologists. LE is characterized by an increased number of intraepithelial lymphocytes without granulocytosis in the esophagus [5]. It appears to have a benign course in most patients and is most commonly found in older females and in younger patients with inflammatory bowel disease, specifically Crohn's Disease.…”

“…Intraepithelial lymphocytes in the esophagus are relatively common and the differential is broad, to include gastroesophageal reflux, lymphocytic esophagitis, changes associated with radiation therapy, and mucosal changes in motility disorders [2]. Diagnosis includes a biopsy with a high number of intraepithelial lymphocytes in the peripapillary areas (more than 35 lymphocytes per high power field) in addition to the absence of both eosinophils and granulocytes and severe spongiosis [5].…”

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

“…Lymphocytic esophagitis was found in 0.09% of esophageal biopsies obtained by endoscopy in a study of 129,252 adult patients [2]. The characteristic histologic pattern consists of a lymphocytic intraepithelial infiltration with a peripapillary distribution associated with no or few granulocytes and spongiosis [3]. This increasingly recognized condition should be part of the differential diagnosis of dysphagia.…”