Clinical, endoscopic, and histologic characteristics of lymphocytic esophagitis: a systematic review
Lymphocytic esophagitis (LyE) is a novel, yet poorly described, clinicopathologic entity. The aim of this systematic review was to characterize the demographic, clinical, endoscopic, and histologic features of LyE in observational studies of adult and pediatric patients.
We searched the Embase, MEDLINE, and SCOPUS databases for relevant studies in 2018. Two authors reviewed and extracted data from studies that met the inclusion and exclusion criteria.
We identified 20 studies for analysis of demographic, clinical, and endoscopic features of LyE. The mean age ranged from 9 to 67 years. When pooled, there were 231 (52.7%) patients with LyE that were female. The most common presenting symptom was dysphagia reported in 191 (48.8%) patients. On endoscopy, most patients with LyE tended to have abnormal findings (69.0%), which included erosive esophagitis, multiple esophageal rings, linear furrows, and narrow-caliber esophagus. In the 31 studies used to assess the histologic definition, the cut-off number of intraepithelial lymphocytes (IELs) was reported in 16 (51.6%) studies, peripapillary IEL specification in 18 (58.1%) studies, and presence of spongiosis in 6 (19.4%) studies.
We identified a spectrum of demographic, clinical, and endoscopic findings characteristic of patients with LyE. A consensus on the diagnostic criteria of LyE is required.
KeywordsLymphocytic esophagitis Dysphagia Gastroesophageal reflux disease (GERD) Diagnostic criteria
Gastroesophageal reflux disease
Narrow-band imaging magnifying endoscopy
Transition electron microscopy
We would like to thank Kaitlin Fuller and David Lightfoot for their assistance in formatting the search strategy and Roger Chow for administrative assistance.
Study conception and design: MH, MAS, GPK, SCG. Data acquisition: MH, MAS, MR, AA-M. Analysis and interpretation of data: MH, MAS, AR, SCG. Drafting of the manuscript: MH, MAS, AR, RK, SCG. Study supervision: SCG. Critical revision of the manuscript for important intellectual content: MH, MAS, AR, RK, MR, AA-M, MJA, TJ, AS, GPK, CJS, SCG. Final manuscript approval: MH, MAS, AR, RK, MR, AA-M, MJA, TJ, AS, GPK, CJS, SCGrover.
Compliance with ethical standards
This study was approved by the research ethics board of the University of Toronto.
Conflict of interest
Samir C. Grover reports consulting fees from AbbVie, Takeda, and Ferring, research support from AbbVie, Janssen, and Takeda, and has ownership shares in Volo Healthcare; all outside of the scope of this study.
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