Clinical Spectrum and Outcomes of Lymphocytic Esophagitis: Evidencefrom a Retrospective Multicenter Cohort

Introduction:: Lymphocytic esophagitis (LE) is an uncommon inflammatory condition characterized by increased intraepithelial lymphocytes (>20/HPF) with minimal granulocytes. Its etiology, clinical profile, and natural history remain poorly understood. This study aimed to characterise the clinical features, associated conditions, endoscopic and histologic findings, and outcomes of LE across multiple centers. Methods:: A retrospective multicenter study included 110 adults diagnosed with LE between 2008 and 2020 at four tertiary centers. Patients were classified as having mild (20–35 IELs/HPF) or moderate-to-severe (>35 IELs/HPF) disease. Clinical characteristics, comorbidities, endoscopic features, and follow-up outcomes were analysed. Sixty-two patients had longitudinal data from clinic visits or structured telephone follow-up. results: Among 110 patients with LE, GERD, inflammatory bowel disease, and rheumatoid arthritis were common comorbidities, whereas diabetes, asthma, and hypothyroidism were less frequent. Initial symptoms were primarily dysphagia, regurgitation, retrosternal chest pain, nausea/vomiting, odynophagia, and hiccups. Follow-up visits of 62 patients showed similar symptom prevalence. One-third of patients visited the emergency room, with 20% of visits due to gastrointestinal causes; one-fourth required hospitalization, with 10% for GI reasons. Endoscopically, nearly 50% had normal-appearing mucosa, with frequent findings of esophagitis and rings, while strictures, erythema, and furrows were less common. Follow-up endoscopy of 18 patients showed normal mucosa in 76.19%. Esophageal dilation was performed on 20 patients to address dysphagia. Overall, 56.45% of patients reported symptom improvement, the highest in hiccups (75%) and the lowest in odynophagia (42.86%). Results:: LE primarily affected older women (mean age 65.2 years; 3:1 female predominance). Common comorbidities included GERD (46%), Crohn’s disease (17%), and rheumatoid arthritis (15%). Dysphagia (58%) was the predominant symptom. Endoscopy was normal in 47% of cases; esophagitis and oesophageal rings were identified in 20% and 15%, respectively. Over follow-up, the condition of 56% patients improved with proton pump inhibitors, while 18% required dilation for refractory dysphagia. Discussion:: LE appears to be a heterogeneous but generally benign disorder with frequent overlap with autoimmune and reflux-related conditions. Its subtle endoscopic appearance underscores the need for histologic evaluation. Although most patients respond to conservative therapy, a subset develops persistent dysphagia suggestive of fibrotic remodelling. Conclusion:: LE predominantly affects older women and often coexists with immune-mediated or reflux disorders. Prognosis is favorable with medical management, though standardised diagnostic criteria and prospective studies are needed to guide optimal care.