Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2017; 23(6): 949-956
Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.949
Lymphocytic esophagitis: Still an enigma a decade later
Carol Rouphael, Ilyssa O Gordon, Prashanthi N Thota
Carol Rouphael, Department of General Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Ilyssa O Gordon, Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Prashanthi N Thota, Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: All authors contributed to this paper with conception and design of the study, literature review and analysis, drafting, revision and final approval of the manuscript.
Conflict-of-interest statement: All authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Prashanthi N Thota, MD, FACG, Director, Esophageal Center, Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States.
Telephone: +1-216-4440780 Fax: +1-216-4454222
Received: October 24, 2016
Peer-review started: October 27, 2016
First decision: December 2, 2016
Revised: December 14, 2016
Accepted: January 18, 2017
Article in press: January 18, 2017
Published online: February 14, 2017

Lymphocytic esophagitis (LE) is a clinicopathologic entity first described by Rubio et al in 2006. It is defined as peripapillary intraepithelial lymphocytosis with spongiosis and few or no granulocytes on esophageal biopsy. This definition is not widely accepted and the number of lymphocytes needed to make the diagnosis varied in different studies. Multiple studies have described potential clinical associations and risk factors for LE, such as old age, female gender and smoking history. This entity was reported in inflammatory bowel disease in the pediatric population but not in adults. Other associations include gastroesophageal reflux disease and primary esophageal motility disorders. The most common symptom is dysphagia, with a normal appearing esophagus on endoscopy, though esophageal rings, webs, nodularities, furrows and strictures have been described. Multiple treatment modalities have been used such as proton pump inhibitors and topical steroids. Esophageal dilation seems to be therapeutic when dysphagia is present along with esophageal narrowing secondary to webs, rings or strictures. The natural history of the disease remains unclear and needs to be better delineated. Overall, lymphocytic esophagitis seems to have a chronic and benign course, except for two cases of esophageal perforation in the literature, thought to be secondary to this entity.

Keywords: Lymphocytic esophagitis, intraepithelial lymphocytes, spongiosis, gastroesophageal reflux disease, CD4 T-cells, dysphagia, inflammatory bowel disease, esophageal rings, proton pump inhibitors, esophageal dilation

Core tip: Lymphocytic esophagitis has recently been described in 2006 and subsequently, multiple groups have attempted to describe its clinical associations and risk factors with minimal information available on treatment. We performed a PubMed search of all case reports and retrospective studies published in English about lymphocytic esophagitis. The objective of this paper is to present a scientific review of all aspects of this emerging clinical entity known to date.