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      Lymphocytic Esophagitis Presenting With Food Impaction

      case-report
      1 , , 1 , 2 , 2 , 3
      ,
      Cureus
      Cureus
      esophagus, food impaction, esophagitis, dysphagia, lymphocytic esophagitis

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          Abstract

          Lymphocytic esophagitis (LyE) is a rare diagnosis made on esophageal biopsy whose pathogenesis is poorly understood. Since its appearance in the literature 15 years ago, it still remains an enigma due to its low prevalence. In this case report, a 71-year-old male presented with an episode of acute dysphagia due to food impaction. Urgent endoscopy was performed to fragment the food bolus. Repeat endoscopy showed a stricture, and lymphocytic esophagitis was found on esophageal biopsy. A proton pump inhibitor (PPI) was initiated with symptomatic improvement. With its increasing prevalence, lymphocytic esophagitis should be on the differential for causes of dysphagia.

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          Most cited references10

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          Lymphocytic oesophagitis: clinicopathological aspects of an emerging condition.

          Lymphocytic oesophagitis (LyE) has been reported in small series, but no consistent clinical correlations have emerged. The authors sought to determine the prevalence of LyE in a large population and define demographic, endoscopic and clinical findings associated with this condition.
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            Lymphocytic esophagitis: a histologic subset of chronic esophagitis.

            A novel histologic phenotype of chronic esophagitis, ie, lymphocytic esophagitis, is reported in 20 patients. Lymphocytic esophagitis is characterized by high numbers of intraepithelial lymphocytes (IELs) gathered mainly around peripapillary fields and by none (n = 12) to occasional (n = 8) CD15+ intraepithelial granulocytes. IELs expressed CD3, CD4 (42%), CD8 (36%), and granzyme B (0.2%), whereas T-cell intracytoplasmic antigen (TIA) 1 was not expressed. Of the 20 patients, 11 (55%) were 17 years or younger. Of 20 patients, 5 had no symptoms in the upper gastrointestinal tract. Only 4 (20%) of 20 patients had symptoms of gastroesophageal reflux disease and 6 (30%) of gastroduodenitis; 2 (10%) had celiac disease; 4 (20%) had carcinoma of the esophagus (1) or elsewhere (3); 1 (5%) each had hiatus hernia, gastric ulcer/asthma/blood hypertension, Hashimoto thyroiditis, and cirrhosis/diabetes; and 8 (40%) had Crohn disease. Hence, a novel histologic phenotype of chronic esophagitis called lymphocytic esophagitis is reported. Because phenotype is defined as the visible features resulting from the interaction between the genetic makeup and the environment, it is suggested that those factors might have a decisive role in the development of lymphocytic esophagitis.
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              Lymphocytic esophagitis: a diagnosis of increasing frequency.

              Despite being found with increasing frequency on esophageal biopsies, the clinical significance of lymphocytic esophagitis (LE) remains poorly understood.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                2 August 2023
                August 2023
                : 15
                : 8
                : e42873
                Affiliations
                [1 ] Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, USA
                [2 ] Division of Gastroenterology, Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, USA
                [3 ] Department of Gastroenterology and Hepatology, Carl T. Hayden Phoenix Veterans Administration (VA) Medical Center, Phoenix, USA
                Author notes
                Article
                10.7759/cureus.42873
                10474306
                37664363
                11e64bff-6f31-4638-bdb6-5d268c90968b
                Copyright © 2023, Aboona et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 August 2023
                Categories
                Internal Medicine
                Gastroenterology

                esophagus,food impaction,esophagitis,dysphagia,lymphocytic esophagitis

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