A Comparative Analysis between Lymphocytic Esophagitis and Eosinophilic Esophagitis.

introductionLymphocytic Esophagitis (LyE) and Eosinophilic Esophagitis (EoE) share many clinical and endoscopic features. However, their treatment outcomes and prognoses differ significantly. LyE, the least recognized form of esophagitis, requires further research. This study compares symptoms, risk factors, and endoscopic findings in LyE and EoE patients.

methodsThis retrospective cohort study reviewed medical records, esophagogastroduodenoscopy (EGD) findings, and biopsy data. Patients with gastrointestinal symptoms who underwent EGD-guided segmental esophageal biopsies between March 2018 and January 2024 were included. Demographic data, clinical features, risk factors, and EGD findings were compared between LyE, EoE, non-specific esophagitis (NSE), and normal esophageal histology (NEH) groups. The LyE and EoE groups were compared and statistically analyzed with a third comparison group formed jointly by NSE and NEH subgroups.

resultsThe cohort included 11 LyE cases (1.25%), 79 EoE cases (8.96%), 447 NSE cases (50.68%), and 345 NEH cases (39.11%). LyE patients were older, with a mean age of 54.81 years, and 72.72% of them were female. In contrast, EoE patients were younger, with a mean age of 43.52 years, and had a male predominance. Cases of dysphagia, dyspepsia, and nausea or vomiting occurred in both groups. Food impaction was more frequent in EoE. Smoking, alcohol use, and autoimmune diseases (e.g., hypothyroidism and rheumatoid arthritis) were significant risk factors for LyE. Atopic conditions such as asthma and allergies were linked to EoE. Endoscopic findings often overlapped in LyE and EoE. Esophagitis and strictures were more common in LyE, while rings and furrows were more frequent in EoE. All endoscopic findings, including normal mucosa, were significant in LyE and EoE compared to the comparison group. However, rings, linear furrows, and exudates were not significant when comparing LyE to the comparison group. DISCUSSION: This single-center study, limited by a small sample size and geographic scope, addresses the diagnostic challenges posed by overlapping features of Lymphocytic and Eosinophilic Esophagitis. Despite the lack of standardized definitions and variable diagnostic thresholds in previous literature, our use of uniform histopathological criteria (≥20 lymphocytes or eosinophils per HPF) and a large control group enhances the consistency and reliability of the findings.

conclusionLyE is a rare form of esophagitis with clinical and endoscopic features similar to EoE. Accurate histopathological diagnosis is essential for differentiation. LyE is more common in older females with autoimmune conditions, while EoE affects younger males with atopic conditions.