Recurrent dysphagia in a patient with chronic lymphocytic esophagitis

An 82-year-old woman presented with intermittent dysphagia to solid food of several months’ duration. The barium esophagogram (A) demonstrated an area of narrowing in the cervical esophagus. An EGD showed a possible web in the cervical esophagus and a possible distal esophageal ring. An esophageal dilatation resulted in symptomatic improvement. She presented 2 years later with an acute food impaction. An upper endoscopy showed multiple rings throughout the entire esophagus (B). There were stenotic areas in the proximal esophagus (C) and at the esophagogastric junction. The passage of the endoscope encountered resistance and resulted in several deep mucosal lacerations (D). The patient’s dysphagia improved for about 10 months. A repeated endoscopy 1 year later demonstrated similar findings and marked resistance to the passage of the endoscope. Deep longitudinal rents were observed after the passage of the standard-size endoscope. Esophageal biopsy specimens (E) showed spongiotic squamous mucosa with mostly T cell lymphocytic infiltration, elongated vascular papillae, and basal cell hyperplasia; parakeratosis, eosinophils, fungus, and viral inclusions were not identified. Lymphocytic esophagitis is an uncommon chronic inflammatory esophageal disease causing recurrent dysphagia. This condition is clinically and endoscopically similar to eosinophilic esophagitis.