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Lymphocytic Esophagitis: A Diagnosis of Increasing Frequency

Cohen, Shirley MD*; Saxena, Aditi MD*; Waljee, Akbar K. MD, MSc*; Piraka, Cyrus MD*; Purdy, Julianne MD; Appelman, Henry MD; McKenna, Barbara MD; Elmunzer, B. Joseph MD*; Singal, Amit G. MD, MS§,∥

doi: 10.1097/MCG.0b013e3182500de8
ALIMENTARY TRACT: Original Articles

Background: Despite being found with increasing frequency on esophageal biopsies, the clinical significance of lymphocytic esophagitis (LE) remains poorly understood.

Goals: The primary aim of our study was to characterize the clinical presentation and natural history of LE among adult patients.

Study: We retrospectively reviewed records for all 81 adult patients at the University of Michigan Medical Center who had a histopathologic diagnosis of LE between January 1998 and November 2009. Patient demographics, clinical history, laboratory data, and imaging results from the time of diagnosis were obtained through review of computerized medical records. A telephone survey was conducted to collect natural history data.

Results: The number of LE diagnoses increased over time, with 81.5% (n=66) of patients being diagnosed in the last 3 years. The most frequent symptoms at the time of presentation were dysphagia (n=54), chest/abdominal pain (n=36), and heartburn (n=38). The majority (58.6%) of patients reported improvement in their initial gastrointestinal symptoms—most commonly associated with initiation of a proton pump inhibitor. Upon follow-up, most patients reported a good quality of life and satisfaction with their current health status.

Conclusions: LE is a new clinical entity with an increasing incidence. LE seems to have a benign natural history, with most patients reporting an improvement in symptoms and satisfaction with their health-related quality of life. Prospective studies are needed to better characterize the natural history and potential treatments for this clinical entity.

Departments of *Internal Medicine

Pathology, University of Michigan, Ann Arbor, MI

Department of Pathology, Poplar Healthcare, Memphis, TN

§Department of Internal Medicine, Division of Digestive and Liver Diseases

Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX

All of the listed authors have made substantial contributions to the conception and design of the study, acquisition of data and/or analysis and interpretation of the data, drafting of the manuscript, and final approval of the version to be submitted.

A.G.S.’s research is supported by Grant KL2 RR024983-04 and UL1 RR024982. B.J.E. and A.W.’s research is supported by Grant UL1RR024986 from the National Center for Research Resources (NCRR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCRR, or the National Institutes of Health.

The authors declare that they have nothing to disclose.

Reprints: Amit G. Singal, MD, MS, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5959 Harry Hines Boulevard, POB 1, Suite 420, Dallas, TX 75390-8887 (e-mail: amit.singal@utsouthwestern.edu).

Received October 6, 2011

Accepted February 13, 2012

© 2012 Lippincott Williams & Wilkins, Inc.