Lymphocytic Esophagitis Presenting as Chronic Dysphagia

Kasirye, Yusuf; John, Abie; Rall, Christopher; Resnick, Jeffrey M.

doi:10.3121/cmr.2011.1009

Cited by 17 publications

(13 citation statements)

References 6 publications

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“…However, the possible association between smoking and LyE has not been previously observed. The pathogenesis of LyE is yet unknown, but it has been hypothesized that possible causes of LyE may include a hypersensitivity reaction to an ingestant or an autoimmune phenomenon [1,3,4,14]. Additionally, it has been proposed that LyE may be an early sign of GERD in patients with no other endoscopic findings [10,18].…”

Section: Discussionmentioning

confidence: 99%

Lymphocytic Esophagitis: An Emerging Clinicopathologic Disease Associated with Dysphagia

et al. 2016

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Background Lymphocytic Esophagitis (LyE) is a recently described clinicopathological condition, but little is known about its features and clinical associations. Aim To characterize patients with LyE, compare them to non-LyE controls, and identify risk factors. Methods We conducted a retrospective study of all patients ≥18 years old who underwent upper endoscopy with esophageal biopsy between January 1, 2000 and June 1, 2012. Archived pathology slides were re-reviewed and LyE was diagnosed if there was lymphocyte-predominant esophageal inflammation with no eosinophils or granulocytes. Three non-LyE controls groups were also defined: reflux, eosinophilic esophagitis (EoE), and normal. Clinical data were extracted from electronic medical records, and LyE cases were compared to non-LyE controls. Results 27 adults were diagnosed with LyE, and the majority were female (63%). The most common symptom was dysphagia (70%). 52% had a prior or current diagnosis of reflux. Endoscopic findings included strictures (37%), erosive esophagitis (33%), rings (26%), and hiatal hernia (26%); 33% of patients required dilation. After histology re-review, 78% of LyE patients were found to have more than 20 lymphs/hpf. In comparison to the normal, reflux and EoE controls, patients with LyE tended to be non-white (p<0.01), were more commonly tobacco users (p=0.02), and less likely to have seasonal allergies (p=0.02). Conclusion LyE commonly presents with dysphagia due to esophageal strictures which require dilation. Smoking was associated with LyE whereas atopy was not. LyE should be considered as a diagnostic possibility in patients with these characteristics undergoing upper endoscopy.

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Section: Discussionmentioning

confidence: 99%

Lymphocytic Esophagitis: An Emerging Clinicopathologic Disease Associated with Dysphagia

et al. 2016

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“…In up to one‐third of patients, the mucosa may be completely normal, while in others the mucosal surface shows rings, furrows, as well as strictures similar to those seen in patients with EoE (Fig. ) . EoE‐like changes seem to develop throughout the esophagus, with the mid‐esophagus being usually involved in conjunction with involvement of the proximal or distal esophagus.…”

Section: Endoscopic Appearance Of Lymphocytic Esophagitis and Overlapmentioning

confidence: 93%

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

Patil

Hammer

Langer

et al. 2018

Annals of the New York Academy of Sciences

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Lymphocytic esophagitis is a histologic pattern of injury characterized by increased intraepithelial lymphocytes (>20/high-power field) with rare, or absent granulocytes. Lymphocytes tend to be more numerous in the peripapillary epithelium, and are often associated with evidence of mucosal injury, edema, and scattered dyskeratotic cells. More than a decade following its original description, lymphocytic esophagitis remains an enigmatic entity with variable clinical presentations, associated disorders, etiologies, treatment, and natural history. Most of the confusion regarding the clinical significance of this disorder stems from its diagnostic criteria: lymphocytic esophagitis is currently defined based entirely on histologic criteria, despite the common occurrence of lymphocytosis in a variety of unrelated inflammatory conditions of the esophagus. The goal of this review is to summarize the literature regarding lymphocytic esophagitis and focus on key clinicopathologic features that distinguish it from other esophageal disorders that can show increased numbers of intraepithelial lymphocytes.

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“…However, it would not be unreasonable to initiate a trial course of PPI or to increase the dose when a diagnosis of LyE is made as it may provide symptomatic benefits. Topical corticosteroids ( e.g ., fluticasone) is another proposed course of treatment[16]. This is because corticosteroids are beneficial in other gastrointestinal lymphocytic and autoimmune diseases[17-19], and swallowed fluticasone in particular has been shown to induce histological remission in EoE[18].…”

Section: Discussionmentioning

confidence: 99%

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

Jideh¹,

Keegan²,

Weltman³

2016

WJCC

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Lymphocytic esophagitis (LyE) is a rare condition characterised histologically by high numbers of esophageal intraepithelial lymphocytes without significant granulocytes infiltration, in addition to intercellular edema (“spongiosis”). The clinical significance and natural history of LyE is poorly defined although dysphagia is reportedly the most common symptom. Endoscopic features range from normal appearing esophageal mucosa to features similar to those seen in eosinophilic esophagitis, including esophageal rings, linear furrows, whitish exudates, and esophageal strictures/stenosis. Symptomatic gastroesophageal reflux disease is an inconsistent association. LyE has been associated in paediatric Crohn’s disease, and recently in primary esophageal dysmotility disorder in adults. There are no studies assessing effective treatment strategies for LyE; empirical therapies have included use of proton pump inhibitor and corticosteroids. Esophageal dilatation have been used to manage esophageal strictures. LyE has been reported to run a benign course; however there has been a case of esophageal perforation associated with LyE. Here, we describe the clinical, endoscopic and histopathological features of three patients with lymphocytic esophagitis along with a review of the current literature.

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Lymphocytic Esophagitis Presenting as Chronic Dysphagia

Cited by 17 publications

References 6 publications

Lymphocytic Esophagitis: An Emerging Clinicopathologic Disease Associated with Dysphagia

Lymphocytic Esophagitis: An Emerging Clinicopathologic Disease Associated with Dysphagia

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

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

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