406 Lymphocytic and Eosinophilic Esophagitis: A Comparative Study

Abstract

INTRODUCTION: While the histopathologic criteria for the diagnosis of eosinophilic esophagitis (EoE) and the related clinical and endoscopic manifestations are well established, little is known about lymphocytic esophagitis (LyE). The aim of this study was to determine whether significant correlations exist between the numbers of intraepithelial lymphocytes (IEL) in esophageal biopsies and clinical and endoscopic manifestations usually associated with EoE. METHODS: H&E slides from esophageal biopsies from 331 conscutive patients were reviewed. The number of IEL and intraepithelial eosinophils (IEE) per mm2 was counted in the area with highest concentration in each biopsy. The numbers were then correlated with clinical and endoscopic findings. RESULTS: As expected, the mean number of IEE was significantly higher in patients with complaints of food impaction (149 vs 38, P < 0.001) and dysphagia (91 vs 38, P = 0.002) and with rings (161 vs 39, P < 0.001), furrows (207 vs 48, P < 0.001) or strictures (136 vs 51, P = 0.008) typical with EoE seen on endoscopy compared to those without these complaints or findings. By contrast, there were no significant increase in mean IEL in patients complaining of food impaction (136 vs 153, P = 0.554) or dysphagia (152 vs 154, P = 0.902) or with rings (131 vs 154, P = 0.357), furrows (130 vs 152, P = 0.569) or strictures (118 vs 153, P = 0.0332) seen on endoscopy. Mean IEL was higher in smokers (180 vs 139, P = 0.029) and high IEL showed positive correlation with rings on endoscopy (P = 0.013, Spearman’s Rank), history of alcohol use (P = 0.015) and almost correlated with food impaction (P = 0.059). Interestingly, there was weak but significant negative correlation between IEL and IEE (r = -0.299, P < 0.001). CONCLUSION: In contrast to IEE in EoE, our study failed to show significant correlation between IEL and major clinical and endoscopic findings usually associated with EoE.