A subtle stricture!
A somewhat scary dilatation.
WHAT IS THE LIKELY AETIOLOGY OF THE STRICTURE?
a) peptic stricture
There are no linear reflux ulcers!
b) eosinophilic oesophagitis
yes! Long and fusiform stricture and mucosa 'splits' in a frightening way
Those IPCL's do look a little prominent but not ectatic etc
But the stricture is within the squamous part of the oesophagus!
Eosinophilic oesophagitis was first described in 1978 and is widely regarded as an allergic condition. Food allergy may play a significant role and the majority of sufferers have either personal or family history of other allergic conditions.
In contrast, Lymphocytic oesophagitis is much more recent, first described by Rubio et al in Sweden in 2006. As yet there is no consensus on how many lymphocytes are needed to make the diagnosis. Extrapolating from EoE, I take 2 samples from the proximal, middle and distal oesophagus respectively, in all patients with inexplicable dysphagia.
LyC oesophagitis is still regarded as something of an entity "in search of a disease". For this reason it's difficult to know if the reported increasing prevalence is simply due to the pathologists being on the lookout and more oesophageal samples (correctly) being taken in patients with dysphagia.
There is an association with old age, female gender, smoking, reflux disease and primary esophageal motility disorders.
Clinically oesophageal rings, webs, nodularities, furrows and strictures have been described in both conditions. Personally, I think that they look subtly different! I suggest a LyC oesophagitis when there is subtle dilatation of the intrapapillary capillary loops within the squamous oesophagus. In my experience you don't usually see this in EoE. For this reason, a lymphocytic oesophagitis would have been a very reasonable guess in this case. Those IPCL's do look a little dilated don't they? Of course, strictures are supposedly far less common in LyC oesophagitis than in EoE.