Lymphocytic Esophagitis A Chronic or Recurring Pattern of Esophagitis Resembling Allergic Contact Dermatitis

Department of Pathology, University of Michigan, Ann Arbor, MI 48109-0054, USA.
American Journal of Clinical Pathology (Impact Factor: 2.51). 11/2008; 130(4):508-13. DOI: 10.1309/D3PCF6D6YYMQRX9A
Source: PubMed


Lymphocytic esophagitis (LE) is characterized by intraepithelial lymphocytes (IELs) and spongiosis, resembling contact dermatitis. LE has been defined as high numbers of IELs and no or rare granulocytes and was found in young patients and in association with Crohn disease (CD). We reviewed the medical records of 42 LE cases. Cases were divided into severe (IELs in interpapillary and peripapillary fields) and mild (IELs in peripapillary fields) LE. The control group included specimens from 34 consecutive esophageal biopsy cases. Mean ages were similar (LE, 44 years; control subjects, 43 years). CD was present in 5 LE cases (12%) and 1 control case, an insignificant difference. Of patients with LE, 14 (33%) had an allergy; 11 (26%), gastroesophageal reflux disease (GERD); 4 (10%), Helicobacter pylori gastritis; and 18 (43%), dysphagia. No differences were found in clinical features between LE and control cases, except GERD was less common in severe LE (6/30 [20%]) than in control cases (17 [50%]). No patient with LE had celiac disease. No medications were common among LE cases. Patients with LE are statistically no more likely than control subjects to have CD. We found no association between LE and any clinical condition or symptom. Based on sequential biopsies in 7 patients, LE seems to be a chronic disease.

40 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die lymphozytäre Ösophagitis stellt eine seltene, nicht eindeutig definierte, chronisch-entzündliche Erkrankung der Speiseröhre dar, die durch eine erhöhte Anzahl intraepithelialer Lymphozyten charakterisiert ist. Bis jetzt konnten weder klinische Symptome noch endoskopische Befunde eindeutigen histologischen Kriterien zugeordnet werden. So bleibt die Erkrankung derzeit noch eine Ausschlussdiagnose nach Exklusion aller anderen potenziellen Ursachen einer ösophagealen intraepithelialen Lymphozytose.
    Der Pathologe 03/2013; 34(2). DOI:10.1007/s00292-012-1726-1 · 0.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The 8th annual Current Topics in Gastrointestinal and Liver Pathology course was held on the campus of the Johns Hopkins Medical Institutions in Baltimore, MD, USA, on the 8-9 November 2008. Lectures and hands-on microscopy sessions were provided by the Johns Hopkins Division of Gastrointestinal Pathology faculty and a guest faculty member from the University of Michigan (MI, USA). Key topics included newly recognized staging issues, the application of molecular techniques and practical topics for diagnostic pathologists.
    Expert review of gastroenterology & hepatology 03/2009; 3(1):33-7. DOI:10.1586/17474124.3.1.33 · 2.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Increased numbers of intraepithelial lymphocytes (lymphocytosis) can be found in the esophagus, stomach, small intestine, and colon in a variety of clinical circumstances. This review, directed at practicing pathologists, portrays the normal resident lymphocyte population in the mucosa of each segment of the digestive tract and discusses the different situations that may result in quantitative or qualitative alterations of intraepithelial lymphocytes. Esophageal lymphocytosis has not been fully characterized and its clinical significance, if any, awaits definition. Thus, this diagnosis is presently discouraged. In the stomach, it is particularly important to exclude Helicobacter pylori infection and celiac sprue before diagnosing lymphocytic gastritis. Duodenal lymphocytic infiltrates, inextricably tied with alterations of the villous architecture of the mucosa, are often caused by gluten sensitivity. However, similar morphologic changes may be caused by a vast array of other conditions that must be carefully considered and excluded. Lymphocytic and collagenous colitis are most often unexplained, but their frequent association with autoimmune conditions or certain medications deserve a thorough investigation in each case. Using a combination of histologic and clinical clues, a cause for the intraepithelial lymphocytic infiltration can be identified in many instances. As some of the associated conditions are amenable to effective treatment, the importance of diligently seeking such associations before resorting to a diagnosis of primary lymphocytosis is emphasized.
    Advances in anatomic pathology 10/2009; 16(5):290-306. DOI:10.1097/PAP.0b013e3181b5073a · 3.23 Impact Factor
Show more


40 Reads
Available from