Background: Lymphocytic esophagitis (LE) is an emerging, underrecognized esophageal disorder with dense peripapillary intraepithelial lymphocytic infiltrate and minimal granulocytic inflammation. Its clinical features overlap with gastroesophageal reflux disease (GERD) and eosinophilic esophagitis, making diagnosis difficult. Dysphagia is the most common symptom, and endoscopic findings are variable. Histology is essential. This series highlights endoscopic variability and the importance of biopsies.
Case Report: Five patients with histologically confirmed LE are described.
Case 1: A 73-year-old woman with multinodular goiter presented with recurrent food impaction. EGD showed stenosis at 20 cm, edematous mucosa, and whitish exudates.
Case 2: A 56-year-old man with asthma had dysphagia and heartburn. EGD revealed Los Angeles (LA) grade D esophagitis.
Case 3: A 57-year-old woman with chronic gastritis and autoimmune hepatitis reported dysphagia and pyrosis. EGD showed patchy erythematous mucosa in the proximal and mid esophagus with LA grade A esophagitis.
Case 4: An 83-year-old woman with prior multinodular goiter surgery presented with dysphagia and heartburn. EGD revealed edema, concentric rings, and LA grade B esophagitis.
Case 5: An 88-year-old woman with hypothyroidism, GERD, and chronic gastritis underwent EGD for dysphagia. A single mucosal ring was seen in the cervical esophagus.
Discussion: LE shows wide clinical and endoscopic variability. Symptoms such as dysphagia and food impaction are nonspecific. Endoscopic findings range from normal mucosa to strictures, rings, edema, erythema, or exudates, often mimicking GERD, eosinophilic, or infectious esophagitis. Histology is the diagnostic standard, showing peripapillary lymphocytosis, epithelial damage, and few granulocytes. Because the disease is patchy, multiple biopsies are recommended. Awareness is essential to prevent misdiagnosis and guide management, typically acid suppression and treatment of associated conditions.
Conclusion: LE is a rare, challenging diagnosis. This series emphasizes heterogeneous presentation and the importance of biopsies. Increased clinician awareness may improve diagnostic accuracy and outcomes.