Lymphocytic Esophagitis: A Histologic Pattern of Various Underlying Disorders

Background: Lymphocytic esophagitis (LyE) is a rare condition that has been reported in several case studies, but its diagnostic criteria and clinical significance are inconsistent. There are no established clinical associations, except for Crohn's disease in children. Our study aimed to determine if patients with LyE have distinct demographic or clinical characteristics when compared with patients with increased intraepithelial lymphocytes (IEL) in their esophageal biopsy. Methods: We conducted a retrospective review of all esophageal biopsies between 2008 and 2023 in 2 medical centers. After excluding cases that met criteria for specific disorders, we identified all cases with increased IEL and compared their clinical, demographic, and endoscopic characteristics to those of LyE. Results: We identified 381 cases with increased IEL, of which 15 met the criteria for LyE. Patients diagnosed with LyE showed no distinctive demographic, endoscopic, or associated morbidities. The gradual increase in esophageal IEL was not associated with any differences in demographic, endoscopic, or clinicopathologic findings. Conclusion: Our findings suggest that lymphocytic esophagitis is not a well-defined clinicopathologic entity but rather a rare and nonspecific histologic pattern associated with various esophageal disorders. Further studies should aim to differentiate between the underlying causes of this histologic pattern, rather than defining it as a single clinicopathologic entity.