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Lymphocytic esophagitis: a histologic pattern with emerging clinical ramifications.

Mikhail Lisovsky1, Maria Westerhoff2, Xuchen Zhang3

  • 1Department of Pathology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.

Annals of the New York Academy of Sciences
|September 17, 2016
PubMed
Summary

Lymphocytic esophagitis (LyE) is poorly understood but emerging research links it to specific conditions. In adults, LyE with CD4+ T-cells may indicate motility disorders, while GERD is also a possibility.

Keywords:
esophagusgastroesophageal reflux diseaselymphocytic esophagitismotility disorders

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Area of Science:

  • Gastroenterology
  • Pathology
  • Immunology

Background:

  • Lymphocytic esophagitis (LyE) is defined by increased intraepithelial lymphocytes (IELs) without granulocytosis.
  • The clinical significance and associations of LyE are not fully elucidated.
  • LyE diagnosis requires careful pathological evaluation to differentiate it from other esophageal conditions.

Purpose of the Study:

  • To explore the clinical significance and associations of lymphocytic esophagitis (LyE).
  • To identify potential underlying conditions associated with LyE in adults.
  • To highlight the importance of accurate LyE diagnosis for patient management.

Main Methods:

  • Review of existing literature and clinical data on LyE.
  • Analysis of IEL subtypes in adult LyE cases.
  • Correlation of LyE findings with clinical presentations and diagnoses.

Main Results:

  • LyE association with Crohn's disease is noted in children but not adults.
  • In adults, LyE with CD4+ IELs correlates with non-achalasia primary esophageal motility abnormalities.
  • Gastroesophageal reflux disease (GERD) is a potential association.
  • Common symptoms include dysphagia with normal endoscopic findings.
  • LyE mimics conditions like eosinophilic esophagitis.

Conclusions:

  • LyE diagnosis is crucial for identifying associated gastrointestinal disorders.
  • Pathologists play a key role in reporting LyE to guide further clinical evaluation.
  • Understanding LyE associations aids in managing patients with dysphagia and motility issues.