Lymphocytic Esophagitis: Navigating an Uncharted Territory

Area of Science:

• Gastroenterology
• Pathology

Background:

• Lymphocytic esophagitis (LE) is a rare esophageal inflammation characterized by increased intraepithelial lymphocytes.
• Its symptoms often overlap with gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE), leading to potential misdiagnosis.
• Limited research exists on LE pathophysiology, necessitating further investigation.

Purpose of the Study:

• To present a case of lymphocytic esophagitis (LE) diagnosed in a patient with recurrent chest pain.
• To highlight the diagnostic challenges and treatment approach for LE.
• To emphasize the importance of considering LE in the differential diagnosis of non-cardiac chest pain.

Main Methods:

• A 47-year-old female presented with a year of recurrent substernal chest pain.
• Esophagogastroduodenoscopy revealed esophageal erosions and edema.
• Biopsies confirmed intraepithelial lymphocytosis (>40 lymphocytes/HPF), diagnosing LE.

Main Results:

• The patient experienced symptom improvement with high-dose proton pump inhibitor (PPI) therapy.
• Recommendations included a low-acid diet and annual endoscopic monitoring.
• Accurate diagnosis of LE is crucial for effective management of non-cardiac chest pain.

Conclusions:

• Lymphocytic esophagitis (LE) can present atypically and mimic other esophageal disorders.
• Biopsy is essential for diagnosing LE, and PPIs are an effective initial treatment.
• Further research and standardized approaches are needed to understand LE and its link to non-cardiac chest pain.