S4194 Lymphocytic Esophagitis: Clinical Insights into a Rare Inflammatory Disorder

Introduction: Lymphocytic esophagitis is a rare, under-recognized disorder characterized by intraepithelial lymphocytosis without granulocytic infiltration. We present a case of an elderly woman with Sjogren's syndrome, esophageal stricture, and gastroesophageal reflux disease, who had longstanding dysphagia and epigastric discomfort subsequently diagnosed with Lymphocytic Esophagitis. Case Description/Methods: An elderly woman with a past medical history of Sjogren's syndrome, esophageal stricture requiring dilation, gastroesophageal reflux disease, and hypertension, presents with a longstanding history of dysphagia with solid foods. She felt a sensation of food being stuck in her esophagus, which slowly passed down. She stated that the problem had been worsening. Patient had multiple esophagogastroduodenoscopies prior to presentation which showed multiple findings including duodenal adenoma, gastric polyps and concentric esophageal rings, which had been dilated. Previous biopsies had been negative for eosinophilic esophagitis. The patient had temporary resolution of symptoms with interventions over many years. She re-presented to the gastroenterology clinic with worsening dysphagia and epigastric pain. Her symptoms were associated with nausea and weight loss. Repeat esophagogastroduodenoscopy was performed and using the endoscopic reference score, showed grade 1 edema, grade 2 rings, grade 1 exudates, grade 1 furrows, and no strictures. The esophageal mucosal changes were suggestive of long-standing lymphocytic esophagitis. Biopsies of the distal and mid esophagus were collected and both revealed squamous mucosa with reactive changes and increased intraepithelial lymphocytes and apoptotic keratinocytes. The overall pattern was consistent with a lymphocytic esophagitis pattern of inflammation. Discussion: Lymphocytic esophagitis is an uncommon and under-recognized form of esophagitis. It is characterized histologically by intraepithelial lymphocytosis without significant granulocytic infiltration. Its etiology and clinical significance remain poorly understood, though it is increasingly identified in esophageal biopsies, particularly in patients presenting with dysphagia or chest discomfort.