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

Abstract

Background and Aim Lymphocytic esophagitis (LoE) is a recently described upper gastrointestinal tract “disorder” diagnosis of which hinges on histology and is characterized by the excessive infiltration of lymphocytes in the peripapillary fields of the esophageal epithelium, with clinical manifestations similar to those of eosinophilic esophagitis (EoE). In this article, we aim to describe for the first time the clinico‐pathological characteristics of a large cohort of Australian (Queensland) cases of LoE. Methods Histological data that fulfilled the criteria (predominant lymphocytic infiltration in the peripapillary fields, none or minimal neutrophils or eosinophils, and no infection) were collected between January 2014 and May 2016 from a number of major Queensland Public Hospital anatomical pathology laboratories. Patient presentations were subsequently examined to compile clinical and endoscopic correlates. Results A total of 62 cases of LoE were identified. The median age was 55 years, with 59.6% of subjects being male. Major clinical manifestations included dysphagia (32), epigastric or abdominal pain (8), gastro‐esophageal reflux (8), association with Crohn's disease (8), and vomiting or diarrhea (6). Endoscopy was normal in 47% of cases; 47% had appearances similar to those of EoE. There were three cases with associated mild monilial esophagitis (6%). Conclusion LoE is a relatively recently recognized condition of the esophagus with variable clinical and endoscopic findings. Diagnosis is based on characteristic histological features. Further investigation is needed to ascertain the etiopathology and natural history of the condition and to establish a safe and effective treatment regimen.

Clinical and morphological diagnosis of eosinophilic esophagitis

“…У пациентов также может возникать острое вклинение пищи в пищевод [39] -состояние, которое наиболее часто выявляется при ЭоЭ. Не только клиническая картина, но и эндоскопические признаки лимфоцитарного эзофагита во многом сходны с таковыми при ЭоЭ [39][40][41][42]. В то же время пациенты с ЭоЭ обычно моложе, и при лимфоцитарном эзофагите отмечается преобладание женщин [43].…”

Novel and rare forms of oesophagitis

“…The most common presenting symptom in all studies is dysphagia, followed by reflux or heartburn, abdominal or chest pain, nausea and/or vomiting and odynophagia. [58][59][60][61][62][63][64] A number of studies have indicated that, relative to those with a normal oesophagus or other forms of oesophagitis, reflux-type symptoms are half as common in those with LO. 59,62 Phlebitis and plexitis, 1/6…”

“…65 Numerous studies in adult patients have failed to support a significant association with chronic inflammatory bowel disease. 57,59,[61][62][63]65 Associations with Helicobacter pylori gastritis, 62 lichen planus 66 and hypothyroidism 58 have also been described.…”

“…The remaining cases of ‘mucosal’ type LO have frequent and persistent diffuse mucosal disease and a high rate of associated immune‐mediated conditions, which include coeliac disease, 59,62 connective tissue disease 64 and Crohn’s disease in the paediatric population 65 . Numerous studies in adult patients have failed to support a significant association with chronic inflammatory bowel disease 57,59,61–63,65 . Associations with Helicobacter pylori gastritis, 62 lichen planus 66 and hypothyroidism 58 have also been described.…”

Concomitant esophageal intramural pseudodiverticulosis and eosinophilic esophagitis: a diagnosis that needs to be histologically proved

“…In fact, other esophageal diseases such as lymphocytic esophagitis share the endoscopic findings of EoE (eg, rings, strictures, furrows) even in 47% of cases. 8 Indeed, these esophageal changes have shown variable positive and negative predictive values for the diagnosis of EoE; therefore, biopsies are mandatory for EoE diagnosis. Response:…”