Lymphocytic esophagitis: Still an enigma a decade later

Area of Science:

• Gastroenterology
• Pathology

Background:

• Lymphocytic esophagitis (LE) is a clinicopathologic entity defined by peripapillary intraepithelial lymphocytosis and spongiosis on esophageal biopsy.
• Diagnostic criteria for LE are not universally accepted, with variations in lymphocyte counts across studies.
• Potential risk factors include advanced age, female gender, and smoking, with associations noted in pediatric inflammatory bowel disease and adult gastroesophageal reflux disease.

Purpose of the Study:

• To review the current understanding of lymphocytic esophagitis, including its definition, clinical associations, diagnostic challenges, and management.
• To highlight the need for further research into the natural history and definitive diagnostic criteria for LE.

Main Methods:

• Literature review of studies describing lymphocytic esophagitis.
• Analysis of reported clinical associations, risk factors, symptoms, and endoscopic findings.
• Summary of treatment modalities and outcomes.

Main Results:

• LE is characterized by intraepithelial lymphocytosis, but precise diagnostic criteria remain debated.
• Common symptoms include dysphagia, often with an endoscopically normal esophagus, though structural abnormalities can be present.
• Treatments like proton pump inhibitors, topical steroids, and esophageal dilation have been employed, with dilation effective for dysphagia associated with narrowing.

Conclusions:

• Lymphocytic esophagitis appears to have a chronic and generally benign course.
• Further research is needed to clarify diagnostic standards, risk factors, and the long-term natural history of LE.
• Esophageal perforation is a rare but serious potential complication.