**4. Clinical manifestations**

Moreover, since it is a novel entity and most of the studies are from North America, world-

A small amount of intraepithelial lymphocytes is normally present in the esophagus [4, 5]. A majority of these lymphocytes are CD8 T cells, whereas CD4 are a minority and usually present in the lamina propria. An increase in CD8 T cells is seen in peptic and eosinophilic esophagitis. In addition, this lymphocytosis is generally accompanied by eosinophils and/or

Compared to other esophageal pathologies, lymphocytic esophagitis is characterized by an isolated lymphocytosis. The main histologic findings are a dense peripapillary intraepithelial lymphocytic infiltrate, an intercellular edema known as spongiosis, as well as the absence or rarity of granulocytes (**Figure 1**) [1]. The intraepithelial lymphocytes express CD3, CD4, and

Unfortunately, because the histologic criteria are not yet standardized, it can sometimes lead to misdiagnosis. For instance, the presence of rare intraepithelial granulocytes is accepted in lymphocytic esophagitis [1, 2, 10, 11]. However, granulocytes can be found in various esophageal diseases, making diagnosis more difficult [11]. The acceptable number of granulocytes

**Figure 1.** Lymphocytic esophagitic (H&E stain, original magnification ×40). Dense peripapillary lymphocytic infiltrate

wide prevalence has not been evaluated.

CD8, as shown by immunohistochemistry [1, 9, 11].

with spongiosis (arrow). Absence of neutrophils and eosinophils.

**3. Histology**

164 Esophageal Abnormalities

neutrophils [5–8].

still needs to be better defined.

Lymphocytic esophagitis seems to affect mostly women around 60 years old and smokers [2, 3, 10, 11]. The most common symptom is dysphagia [2, 8, 11, 13]. Nausea, vomiting, chest pain, heartburn, and episodes of impactions have also been reported; however, dysphagia remains the principal and most frequent complaint in 53% of cases [2, 3, 12]. Patients with lymphocytic esophagitis do not appear to show weight loss or fever.

The most serious complication is esophageal perforation. In 10 years, two cases of perforation have been reported. One of the two perforations occurred after the removal of a piece of impacted meat, while the second case was a spontaneous microperforation [14, 15].
