Abstract
BackgroundLymphocytic esophagitis is a newly recognized entity of unknown origin. Dysphagia is defined as difficulty swallowing and represents a common symptom in the general population with a prevalence of approximately 20%. Chronic inflammation of the esophageal wall may manifest itself clinically and endoscopically, mimicking inflammation of another origin. However, little is known about the pathogenesis of the disease, as patients are seldom suspected and rarely diagnosed with lymphocytic esophagitis.Case presentationHere, we present a rare case of lymphocytic esophagitis in a patient with multiple allergies and suspected eosinophilic esophagitis. A 28-year-old woman with polyvalent sensitization to food and inhalant allergens presented with intermittent dysphagia, a sensation of a foreign body in the throat, itchiness of the oral cavity after ingesting certain foods, heartburn, and prolonged chewing time. A skin prick test showed positive results for birch-tree, alder, hazel, and rye pollen, as well as house dust mites. Apart from obesity (BMI 30 kg/m2), multiple pustules and excoriations on the skin, her physical examination was insignificant. Esophagogastroduodenoscopy (EGD) was performed revealing full-length but discrete trachealization of the esophagus. A barium swallow test showed slowing of esophageal peristalsis in the recumbent position. No esophageal pathology was observed. A histopathological analysis of mucosal samples revealed slight hyperplasia of the basal layer of the esophagus, and the stomach showed changes typical of chronic gastritis.ConclusionsIn summary, this clinical case illustrates that lymphocytic esophagitis, as a newly recognized entity, should be considered in the differential diagnosis of chronic dysphagia. Additionally, when treating allergic patients, clinicians should be aware that lymphocytic esophagitis, distinct from eosinophilic esophagitis, should be considered in the diagnosis of patients with atopy and upper gastrointestinal symptoms.
Highlights
Lymphocytic esophagitis is a newly recognized entity of unknown origin
In summary, this clinical case illustrates that lymphocytic esophagitis, as a newly recognized entity, should be considered in the differential diagnosis of chronic dysphagia
When treating allergic patients, clinicians should be aware that lymphocytic esophagitis, distinct from eosinophilic esophagitis, should be considered in the diagnosis of patients with atopy and upper gastrointestinal symptoms
Summary
Further studies clarifying the pathogenesis, clinical manifestation and progression and most importantly, the course of treatment are required to gain a greater understanding of LyE. The role of allergies in the pathomechanism of LyE remains unclear. The goal of this case report is to draw the attention of allergists to this clinical problem, demonstrating that both EoE and LyE can be suspected in patients presenting with allergies and upper gastrointestinal symptoms. Authors’ contributions OW interview with patient, obtained consent, study design, research material collection, contributed to literature search, critical revision. MŻ-G interview with patient, obtained consent, research material collection, contributed to literature search, evaluated and correct the manuscript. EK-F participated in the design and conception of the study, contributed to literature search, evaluated and corrected the manuscript. AP was involved in project conception, evaluated the study design and the manuscript.
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