Lymphocytic Esophagitis: A Newly Recognized Mimic of Eosinophilic Esophagitis

Abstract

Lymphocytic Esophagitis (LyE) is a type of chronic esophagitis defined by three histologic characteristics: 1) dense peripapillary lymphocytic infiltrates in the esophageal squamous mucosa (termed Peripapillary Lymphocytosis), 2) little to no i ntraepithelial granulocytes within these areas of focus and 3) the presence of spongiosis, or intercellular edema, of the squamous epithelial cells specifically in the areas of focus. This condition has a higher predominance in white females. Patients typically present with symptoms of dysphagia, chest/ abdominal pain and heartburn. Common endoscopic features of LyE include esophagitis, strictures and stenosis, but there is a large portion of patients with a normal appearing esophagus. One technique that shows promise in increasing detection and decreasing sampling error is narrow-band imaging magnifying endoscopy (NBI-ME). Currently, there is no research guiding treatment for LyE, but proton pump inhibitors and swallowed corticosteroids have been used in the past.