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

Abstract

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.

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

“…Despite paucity of reports from Australia (only 4 cases in 2012 and 2016), our large case series now establishes LoE to be a significant pathology here with prevalence similar to other parts of the world and thus would be begging to be recognized and dealt with appropriately. LoE is an increasingly recognized disorder although it is difficult to diagnose due to the nonspecific clinical presentation and the patchy nature of the esophageal lymphocytic infiltrate on biopsy .…”

“…Most patients note symptomatic improvement with PPI alone . However, in the subset of patients presenting with esophageal strictures, repeated dilatations were needed in addition to the above medical therapy . In more benign cases, spontaneous resolution of the histological abnormalities has been noted.…”

“…In 2016, Weltman et al from Australia (NSW) described three adult patients aged 51, 59, and 85 years, presenting with dysphagia. One resolved spontaneously, and another showed minimal symptomatic relief with PPI and topical steroids, while the third patient needed repeat dilatation over the years, despite maximized medical therapy . LoE has recently been associated with primary oesophageal motility disorder.…”

Novel and rare forms of oesophagitis

“…The infiltration of lymphocytes in GORD, radiation oesophagitis and Candida oesophagitis is typically more diffuse. 77 In summary, when diagnosing LO, a biopsy from the mid oesophagus should be used to evaluate for the presence of IELs >20/HPF. Lower oesophageal specimens should be avoided, as increased IELs are common in this region, especially in patients with GORD.…”

“…Finally, when distinguishing LO from secondary causes the peripapillary distribution of lymphocytes in LO may be a helpful clue. The infiltration of lymphocytes in GORD, radiation oesophagitis and Candida oesophagitis is typically more diffuse 77 …”