Clinicopathological and immunophenotypical characterisation of lymphocytic oesophagitis in adults with Crohn's disease.

AIMS: Lymphocytic oesophagitis (LE) is a histological pattern characterised by increased peripapillary lymphocytes and absent or rare granulocytes. Although its association with Crohn's disease (CrD) is established in children, little is known about LE in adult CrD patients. Previous studies have demonstrated immunophenotypical heterogeneity of LE, suggesting its clinical utility in distinguishing CD8 T cell-predominant LE associated with gastroesophageal reflux disease from CD4 T cell-predominant LE associated with other aetiologies. This study aimed to characterise LE and determine its CD4/CD8 immunoprofile in adults with CrD.

METHODS AND

RESULTS

The study included adults with LE and CrD (n = 19) and those without CrD (n = 52). CD4/CD8 lymphocytes were identified by routine immunohistochemistry. The number of lymphocytes was either manually counted or estimated by eye. Compared to patients with LE without Crohn's disease, those with LE and CrD were younger (mean age = 37.9 versus 55.5 years; P < 0.0001), showed oesophageal ulceration (31.6 versus 0%; P = 0.0002) and took fewer medications (median = 4 versus 9; P = 0.0005). LE in CrD was mainly CD4 T cell-predominant (84.2 versus 59.6%; P = non-significant) and with higher CD4/CD8 T cell ratio (median = 2.4 versus 1.1; P < 0.003). When eyeball estimation of CD4/CD8 lymphocyte predominance was compared to actual counting, approximately one-third of total cases showed discordance, with 81% having estimated proportions of CD4/CD8 lymphocytes roughly equal.

CONCLUSIONS

Patients with LE and CrD are characterised by younger age, oesophageal ulceration and CD4-predominant lymphocytic infiltrate.