**7. Treatment**

bowel disease, gastroesophageal reflux disease, celiac disease, asthma, allergies, irritants, or connective tissue diseases (lupus, Behçet's disease), no relationship could be identified

Lymphocytic esophagitis is isolated to the esophagus. It does not coexist with other digestive lymphocytosis such as lymphocytic colitis or lymphocytic gastritis. There is no correlation between these distinct entities. In a case series from Purdy *et al*., some patients had concomitant biopsies from the rest of the digestive tract (stomach, small intestine, or colon). The histologic findings in these biopsies were various and secondary to preexisting conditions. No

One of the main research efforts was to identify a relationship between lymphocytic esophagitis and reflux. Unfortunately, no association has been established between these two conditions [2, 12]. Indeed, only 22 out of 119 patients in the cohort from Haque *et al*. had

In the cohort from Rubio *et al*., 8 of 20 patients had Crohn's disease [1]. However, subsequent studies failed to replicate this association with inflammatory bowel disease [2, 11, 17]. Nevertheless, while it appears that it is not associated with inflammatory bowel disease in adults, lymphocytic esophagitis may be a manifestation of upper gastrointestinal Crohn's disease in the pediatric population [1, 12, 10]. Indeed, seven out of eight Crohn's disease patients from Rubio *et al*. were pediatric cases. Purdy *et al*. confirmed this association with the pediat-

Eosinophilic esophagitis has also been a subject of study and comparison with lymphocytic esophagitis. The clinical and endoscopic manifestations of lymphocytic esophagitis can be confused with those of eosinophilic esophagitis. It is only histology that allows us to differentiate these two entities. Felinization is not pathognomonic of eosinophilic esophagitis,

In a recent cohort from Rubio *et al*., out of 311 biopsies with an increased number of intraepithelial lymphocytes, 33 cases were a compound of lymphocytic esophagitis and eosinophilic esophagitis [9]. We can thus ask whether these are two distinct conditions or whether one is the continuum of the other. However, this assumption remains a hypothesis and requires to be

Since 2014, an interest for esophageal motility disorders in lymphocytic esophagitis has arisen. Recent studies have demonstrated an association with achalasia and primary esophageal motility disorder (nutcracker esophagus, ineffective esophageal motility, and diffuse spasm) [18].

lymphocytic entity was observed in the rest of the gastrointestinal tract [8].

[2, 11–13, 16].

166 Esophageal Abnormalities

**6.1. Gastroesophageal reflux disease**

gastroesophageal reflux disease [2].

**6.2. Crohn's disease**

ric Crohn's disease [1].

studied.

**6.4. Motility disorders**

**6.3. Eosinophilic esophagitis**

hence the importance of biopsy [2].

Treatment of lymphocytic esophagitis remains controversial. Very few studies addressed this subject. Because it is still a recent and rare entity, a majority of therapeutic trials have been reported in the form of case reports or retrospective studies.

Proton pump inhibitor, topical or oral steroids as well as esophageal dilation or injections of Botox have been tried. All these treatments have been partially effective [3, 13–16, 19–21]. Nevertheless, it is too early to establish which treatment is better and should be recommended.

The use of proton pump inhibitor is based on the belief that lymphocytic esophagitis may be associated with esophageal reflux. However, as mentioned earlier, this association remains unclear and unlikely. Nevertheless, given the low toxicity of proton pump inhibitors, we suggest using them as first line of treatment.

Concerning the efficacy of corticosteroids, it may suggest that lymphocytic and eosinophilic esophagitis belong to the same family.
