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Esophagus

, Volume 16, Issue 2, pp 123–132 | Cite as

Clinical, endoscopic, and histologic characteristics of lymphocytic esophagitis: a systematic review

  • Mohamad Habbal
  • Michael A. Scaffidi
  • Amir Rumman
  • Rishad Khan
  • Mirusha Ramaj
  • Ahmed Al-Mazroui
  • Michael J. Abunassar
  • Thurarshen Jeyalingam
  • Akshay Shetty
  • Gabor P. Kandel
  • Catherine J. Streutker
  • Samir C. GroverEmail author
Review Article

Abstract

Objective

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.

Design

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.

Results

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.

Conclusion

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.

Keywords

Lymphocytic esophagitis Dysphagia Gastroesophageal reflux disease (GERD) Diagnostic criteria 

Acronyms

EoE

Eosinophilic esophagitis

GERD

Gastroesophageal reflux disease

hpf

High-power field

IEGs

Intraepithelial granulocytes

IELs

Intraepithelial lymphocytes

LyE

Lymphocytic esophagitis

NBI-ME

Narrow-band imaging magnifying endoscopy

NOS

Newcastle–Ottawa Scale

TEM

Transition electron microscopy

Notes

Acknowledgements

We would like to thank Kaitlin Fuller and David Lightfoot for their assistance in formatting the search strategy and Roger Chow for administrative assistance.

Author contributions

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.

Funding

None.

Compliance with ethical standards

Ethical statement

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.

Supplementary material

10388_2018_649_MOESM1_ESM.docx (158 kb)
Supplementary material 1 (DOCX 157 kb)

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Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Mohamad Habbal
    • 1
  • Michael A. Scaffidi
    • 1
  • Amir Rumman
    • 1
  • Rishad Khan
    • 1
  • Mirusha Ramaj
    • 1
  • Ahmed Al-Mazroui
    • 1
  • Michael J. Abunassar
    • 1
  • Thurarshen Jeyalingam
    • 1
  • Akshay Shetty
    • 1
  • Gabor P. Kandel
    • 1
  • Catherine J. Streutker
    • 2
  • Samir C. Grover
    • 1
    Email author
  1. 1.Division of Gastroenterology, St. Michael’s Hospital, Department of MedicineUniversity of TorontoTorontoCanada
  2. 2.Department of Laboratory Medicine, St. Michael’s HospitalUniversity of TorontoTorontoCanada

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