Lymphocytic esophagitis: a possible manifestation of pediatric upper gastrointestinal Crohn's disease.
BACKGROUND
Lymphocytic esophagitis (LE) is histologically defined by marked esophageal lymphocytosis with no or only rare intraepithelial granulocytes. This study was performed to investigate the association between LE and pediatric Crohn's disease (CD).


METHODS
Blinded retrospective morphologic analysis was performed on gastrointestinal biopsies from pediatric patients with an established diagnosis of CD (n = 60) and ulcerative colitis (UC; n = 30), as well as a spectrum of non-inflammatory bowel disease (IBD) patients (n = 38). The highest density of intraepithelial lymphocytes (IEL), neutrophils (IEN), and eosinophils (IEE) per high power field (hpf; 40×) were counted. LE was defined as >50 IEL/hpf and a ratio of >50:1 IEL to intraepithelial granulocytes (IEG).


RESULTS
LE was identified in 17/60 patients with CD, and only 2/30 patients with UC and 1/38 non-IBD control patients; P = 0.0263 (CD versus UC) and P = 0.0002 (CD versus non-CD). In all, 6/60 CD patients had esophagitis with granulomas and three of these met the diagnostic criteria for LE. There was no difference in the incidence of upper gastrointestinal (UGI) symptoms between the CD patients with LE (7/17, 41%) and CD patients with esophagitis with granulomas (3/6; P = 1.0).


CONCLUSIONS
The histologic diagnosis of LE is associated with pediatric CD and was found in 28% of CD patients. If LE is identified in pediatric CD, it is likely a manifestation of UGI-CD rather than esophagitis due to other etiologies or a variant of normal.
Ebach
Dawn R
DR
Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA. dawn-ebach@uiowa.edu
Vanderheyden
Andrew D
AD
Ellison
Jason M
JM
Jensen
Chris S
CS
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications / Q000473:pathology; D004941:Esophagitis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D041742:Upper Gastrointestinal Tract / Q000473:pathology*; D055815:Young Adult