Lymphocytic esophagitis (LyE) is the finding of a dense lymphocytic infiltrate in the esophageal epithelium, along with spongiosis, in the absence of granulocytes or other causes of esophageal inflammation such as eosinophilic esophagitis or gastroesophageal reflux disease (GERD). It is a novel disease, first described in 2006, that can cause dysphagia and other esophageal dysfunction symptoms. However, its clinical manifestations, endoscopic appearance and risk factors are still in debate, with some authors considering it as a phenotype of esophageal inflammation rather than an independent disease. While Crohn’s Disease is a known risk factor in children, risk factors in adults, as well as the disease, are yet to be determined.

We collectively analysed esophageal biopsy reports and endoscopy reports from two referral centers in Spain from 2000 to 2025. Reports compatible with lymphocytic esophagitis or esophageal intraepithelial lymphocytosis were carefully analyzed with the patient’s clinical history to determine a proper diagnosis of lymphocytic esophagitis. Patients with more than 20 lymphocytes per high power field (LxHPF) in esophageal biopsies were considered as potential patients with LyE. Afterwards, if more than 15 eosinophils per high power field (EoxHPF) or other entities such as candidiasic esophagitis were found, such patients were excluded. As such, only patients with more than 20 LxHPF, less than 15 EoxHPF and no evidence of other esophageal disease were considered as patients with LyE and their clinical records were studied. Regarding endoscopic appearance, we considered an EREFS-like system, describing findings similar to eosinophilic esophagitis, although there was no score calculated on these patients.

Treatment response was considered when, after an onset of treatment, less than 20 LxHPF were found. If no LxHPF were found, it was considered as a complete response.

A total of 7 patients were included from both centers. Women were more frequent than men on a 2.5 ratio with a mean age of 62.43 years. 85% of patients had dysphagia as a symptom, with 28.5% of them presenting with food bolus impaction. Chest pain was also reported on 28.5% of patients. Regarding comorbidities, none of them were recurring in our patients. Only one of them presented autoimmune comorbidities with a case of sclerosing lupus erythematosus (SLE). 

Regarding endoscopic appearance, edema (57.14%) and rings (57.14%) were the most common findings. We have to point out the appearance of panesophagic rings throughout the whole esophagus in these patients, which leads to a macroscopic appearance of trachealization (Figure 1). In our patients, panesophagic affection was more common, reported in 71.43% of cases.

Regarding treatment and response, proton pump inhibitors (PPIs) were the first treatment on all patients, although dosage and PPI of choice differ. Oral budesonide was used in 1 patient but candidiasic esophagitis developed as an adverse effect. While response was found in 2 patients, in 3 patients it was not studied with further endoscopic studies, pointing out a need for standardised protocols in such patients. All these results are summarized in Table 1.

Lymphocytic esophagitis appears to be more frequent in women older than 60 years old. While no comorbidities are associated with this disease, the presence of dysphagia and the endoscopic findings of panesophagic rings should make us consider this disease. While PPIs are an effective treatment, dosage and treatment of choice are still not standardized, as well as follow-up via biopsy.