Wojas O, Żalikowska-Gardocka M, Krzych-Fałta E, Szczepankiewicz B, Samel-Kowalik P, Samoliński B, Przybyłkowski A
Department of Prevention of Environmental Hazard and Allergology, Medical University of Warsaw, Warsaw, Poland.
Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
Allergy Asthma Clin Immunol. 2021 Jun 7;17(1):56. doi: 10.1186/s13223-021-00558-x.
Lymphocytic esophagitis is a newly recognized entity of unknown origin. Dysphagia is defined as difficulty swallowing and represents a common symptom in the general population with a prevalence of approximately 20%. Chronic inflammation of the esophageal wall may manifest itself clinically and endoscopically, mimicking inflammation of another origin. However, little is known about the pathogenesis of the disease, as patients are seldom suspected and rarely diagnosed with lymphocytic esophagitis.
Here, we present a rare case of lymphocytic esophagitis in a patient with multiple allergies and suspected eosinophilic esophagitis. A 28-year-old woman with polyvalent sensitization to food and inhalant allergens presented with intermittent dysphagia, a sensation of a foreign body in the throat, itchiness of the oral cavity after ingesting certain foods, heartburn, and prolonged chewing time. A skin prick test showed positive results for birch-tree, alder, hazel, and rye pollen, as well as house dust mites. Apart from obesity (BMI 30 kg/m), multiple pustules and excoriations on the skin, her physical examination was insignificant. Esophagogastroduodenoscopy (EGD) was performed revealing full-length but discrete trachealization of the esophagus. A barium swallow test showed slowing of esophageal peristalsis in the recumbent position. No esophageal pathology was observed. A histopathological analysis of mucosal samples revealed slight hyperplasia of the basal layer of the esophagus, and the stomach showed changes typical of chronic gastritis.
In summary, this clinical case illustrates that lymphocytic esophagitis, as a newly recognized entity, should be considered in the differential diagnosis of chronic dysphagia. Additionally, when treating allergic patients, clinicians should be aware that lymphocytic esophagitis, distinct from eosinophilic esophagitis, should be considered in the diagnosis of patients with atopy and upper gastrointestinal symptoms.
淋巴细胞性食管炎是一种新发现的病因不明的疾病。吞咽困难被定义为吞咽困难，是普通人群中的常见症状，患病率约为20%。食管壁的慢性炎症可能在临床和内镜下表现出来，类似于其他病因引起的炎症。然而，由于很少怀疑患者患有淋巴细胞性食管炎且很少诊断出该病，因此对其发病机制知之甚少。
在此，我们报告一例罕见的淋巴细胞性食管炎病例，患者有多种过敏症且疑似嗜酸性粒细胞性食管炎。一名28岁对食物和吸入性过敏原多价致敏的女性，出现间歇性吞咽困难、喉咙有异物感、摄入某些食物后口腔瘙痒、烧心以及咀嚼时间延长。皮肤点刺试验显示桦树、桤木、榛树和黑麦花粉以及屋尘螨呈阳性结果。除肥胖（体重指数30kg/m）、皮肤上有多个脓疱和擦伤外，她的体格检查无异常。进行了食管胃十二指肠镜检查（EGD），显示食管全长但呈离散性的气管化。吞钡试验显示卧位时食管蠕动减慢。未观察到食管病变。黏膜样本的组织病理学分析显示食管基底层轻度增生，胃显示出慢性胃炎的典型变化。
总之，该临床病例表明，淋巴细胞性食管炎作为一种新发现的疾病，在慢性吞咽困难的鉴别诊断中应予以考虑。此外，在治疗过敏患者时，临床医生应意识到，在诊断有特应性和上消化道症状的患者时，应考虑与嗜酸性粒细胞性食管炎不同的淋巴细胞性食管炎。
