Lymphocytic Esophagitis: A Newly Recognized Mimic of Eosinophilic Esophagitis

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 intraepithelial 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.