title: Lymphocytic Esophagitis: An Emerging Clinicopathologic Disease Associated with Dysphagia.
abstract: Lymphocytic esophagitis (LyE) is a recently described clinicopathological condition, but little is known about its features and clinical associations.
  
  
  
  The aim of this study was to characterize patients with LyE, compare them to non-LyE controls, and identify risk factors.
  
  
  
  We conducted a retrospective study of all patients ≥18 years old who underwent upper endoscopy with esophageal biopsy between January 1, 2000, and June 1, 2012. Archived pathology slides were re-reviewed, and LyE was diagnosed if there was lymphocyte-predominant esophageal inflammation with no eosinophils or granulocytes. Three non-LyE controls groups were also defined: reflux, eosinophilic esophagitis (EoE), and normal. Clinical data were extracted from electronic medical records, and LyE cases were compared to non-LyE controls.
  
  
  
  Twenty-seven adults were diagnosed with LyE, and the majority were female (63 %). The most common symptom was dysphagia (70 %). Fifty-two percentage had a prior or current diagnosis of reflux. Endoscopic findings included strictures (37 %), erosive esophagitis (33 %), rings (26 %), and hiatal hernia (26 %); 33 % of patients required dilation. After histology re-review, 78 % of LyE patients were found to have more than 20 lymphs/hpf. In comparison with the normal, reflux and EoE controls, patients with LyE tended to be nonwhite (p < 0.01), were more commonly tobacco users (p = 0.02) and less likely to have seasonal allergies (p = 0.02).
  
  
  
  LyE commonly presents with dysphagia due to esophageal strictures which require dilation. Smoking was associated with LyE, whereas atopy was not. LyE should be considered as a diagnostic possibility in patients with these characteristics undergoing upper endoscopy.
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill (UNC-CH), CB#7080, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA.
authors.forename: Sarina
authors.initials: S
authors.lastname: Pasricha
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill (UNC-CH), CB#7080, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Reed
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Speck
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Woosley
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill (UNC-CH), CB#7080, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA. edellon@med.unc.edu.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D003680:Deglutition Disorders / Q000209:etiology*; D057765:Eosinophilic Esophagitis / Q000473:pathology; D004940:Esophageal Stenosis / Q000209:etiology*; D004941:Esophagitis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D004942:Esophagitis, Peptic / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006551:Hernia, Hiatal / Q000453:epidemiology; D006801:Humans; D008218:Lymphocytosis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: Chest pain; Dysphagia; Endoscopy; Heartburn; Lymphocyte