Lymphocytic esophagitis (LE) is a term recently suggested for the finding of >20 intraepithelial lymphocytes/high-power field in an esophageal biopsy with no more than a rare granulocyte. Two prior studies of LE suggested an association of LE with Crohn's disease (CD) in young patients, but there has been no systematic review of a large pediatric cohort to determine the prevalence and clinical associations of LE in children.
All esophageal biopsies performed at a tertiary care pediatric medical center in 2005 were identified (580 biopsies from 545 unique patients). A blinded histologic review was performed to identify LE cases (>50 intraepithelial lymphocytes/high-power field; <1 granulocyte/50 intraepithelial lymphocytes). Clinical characteristics, endoscopic findings, and follow-up data for each case were reviewed independently by a pediatric gastroenterologist.
Thirty-one patients with LE (5.7%) and 49 patients with CD (8.9%) were found among the 545 patients. Six of the 31 LE patients (19%) and 43 of the 514 non-LE patients (8.4%) had CD (P < 0.05). The remaining LE patients had various other clinical diagnoses with no significant clinical correlates. LE was identified in 6 of 49 patients with CD (12.2%) and 25 of 496 patients without CD (5.0%) (P < 0.05). Patients with both LE and CD had a more prominent lymphocytic infiltrate than LE patients without CD.
LE seems to be more prevalent in children than in adults and has a significant association with CD in this age group.
Article first published online 30 June 2014.
Department of *Pathology and
†Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas; and Departments of
§Pediatrics, Children's Medical Center Dallas, Dallas, Texas.
Reprints: Lisa M. Sutton, MD, Department of Pathology, Driscoll Children's Hospital, 3533 South Alameda Drive, Corpus Christi, TX 78411 (e-mail: email@example.com).
Supported in part by the John Lawrence and Patsy Louise Goforth Professorship in Pathology.
A. S. Patel received payment for lectures including service on speakers bureaus from Abbott Nutrition and Janssen. The other authors have no conflicts of interest to disclose.
Received March 20, 2014
Accepted April 30, 2014