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Skinner T, Liang S, Sanagapalli S. Budesonide Orodispersible Tablet for the Treatment of Refractory Esophageal Lichen Planus. ACG Case Rep J 2024; 11:e01460. [PMID: 39176217 PMCID: PMC11340920 DOI: 10.14309/crj.0000000000001460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/28/2024] [Indexed: 08/24/2024] Open
Abstract
Esophageal lichen planus is an uncommon but highly morbid condition where effective treatments are limited. Diagnosis may be challenging and requires a high degree of clinical suspicion considering endoscopic, histopathological, esophageal, and extraesophageal manifestations. We describe a severe case of esophageal lichen planus and recurrent esophageal stricture that was refractory to acid suppression, local and systemic steroid formulations, and dilatation. We present the first reported use of budesonide orodispersible tablet for this condition, including the excellent clinical, endoscopic, and histopathological response.
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Affiliation(s)
- Thomas Skinner
- Division of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Sharron Liang
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- SydPath, St Vincent's Hospital, Sydney, Australia
| | - Santosh Sanagapalli
- Division of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
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2
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Aby ES, Eckmann JD, Abimansour J, Katzka DA, Beveridge C, Triggs JR, Dbouk M, Abdi T, Turner KO, Antunes C, Zhuo J, Kamal AN, Patel P, Gyawali CP, Sloan JA. Esophageal Lichen Planus: A Descriptive Multicenter Report. J Clin Gastroenterol 2024; 58:427-431. [PMID: 37436831 PMCID: PMC10994181 DOI: 10.1097/mcg.0000000000001885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
GOALS To better understand the characteristics, treatment approaches, and outcomes of patients with esophageal lichen planus (ELP). BACKGROUND ELP is a rare, often unrecognized and misdiagnosed disorder. Data on this unique patient population are currently limited to small, single-center series. STUDY A multicenter, retrospective descriptive study was conducted of adults diagnosed with ELP over a 5-year period, between January 1, 2015, and October 10, 2020, from 7 centers across the United States. RESULTS Seventy-eight patients (average age 65 y, 86% female, 90% Caucasian) were included. Over half had at least 1 extraesophageal manifestation. Esophageal strictures (54%) and abnormal mucosa (50%) were frequent endoscopic findings, with the proximal esophagus the most common site of stricture. Approximately 20% had normal endoscopic findings. Topical steroids (64%) and/or proton pump inhibitors (74%) dominated management; endoscopic response favored steroids (43% vs. 29% respectively). Almost half of the patients required switching treatment modalities during the study period. Adjunctive therapies varied significantly between centers. CONCLUSIONS Given its at times subtle clinical and endoscopic signs, a high index of suspicion and biopsy will improve ELP diagnosis, especially in those with extraesophageal manifestations. Effective therapies are lacking and vary significantly. Prospective investigations into optimal treatment regimens are necessary.
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Affiliation(s)
- Elizabeth S. Aby
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition
| | - Jason D. Eckmann
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition
| | - Jad Abimansour
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - David A. Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Claire Beveridge
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Joseph R. Triggs
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Mohamad Dbouk
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tsion Abdi
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin O. Turner
- Department of Pathology, University of Minnesota, Minneapolis
| | - Catiele Antunes
- Division of Digestive Disease and Nutrition, University of Oklahoma, Oklahoma City, OK
| | - Justin Zhuo
- Department of Medicine, Division of Gastroenterology, Stanford University, Stanford, CA
| | - Afrin N. Kamal
- Department of Medicine, Division of Gastroenterology, Stanford University, Stanford, CA
| | - Parth Patel
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
| | - C. Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
| | - Joshua A. Sloan
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition
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3
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Blonski W, Slone S, Jacobs JW. Lichen planus esophagitis. Curr Opin Gastroenterol 2023; 39:308-314. [PMID: 37097828 DOI: 10.1097/mog.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW Dysphagia is one of the most common reasons for patients' visits to a gastroenterologist. Esophageal lichen planus (ELP) has historically been felt to be a rare disease, when in fact it is often misdiagnosed and unrecognized. Often first diagnosed as an unusual esophagitis, all gastroenterologists will see ELP in their practice, and need to be able to recognize this condition. RECENT FINDINGS Although there is still a relative paucity of data on this condition, this article will update the typical presenting symptoms, endoscopic findings, and ways to differentiate ELP from other inflammatory mucosal diseases. There is still no standardized treatment algorithm, but we will also present the most recent treatment approaches. SUMMARY It is critical that physicians maintain an increased awareness of ELP and have a high clinical suspicion in the appropriate patients. While management remains challenging, it is important to treat both the inflammatory and stricturing components of the disease. A multidisciplinary approach is also often required, utilizing dermatologists, gynecologists, and dentists who are familiar with managing patients with LP.
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Affiliation(s)
- Wojciech Blonski
- Joy McCann Culverhouse Center for Swallowing Disorders, Division of Digestive Diseases and Nutrition
- Division of Gastroenterology, James A. Haley Veterans Affairs Hospital, University of South Florida, Tampa, Florida, USA
| | - Samuel Slone
- Joy McCann Culverhouse Center for Swallowing Disorders, Division of Digestive Diseases and Nutrition
| | - John W Jacobs
- Joy McCann Culverhouse Center for Swallowing Disorders, Division of Digestive Diseases and Nutrition
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4
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Decker A, Schauer F, Lazaro A, Monasterio C, Schmidt AR, Schmitt-Graeff A, Kreisel W. Esophageal lichen planus: Current knowledge, challenges and future perspectives. World J Gastroenterol 2022; 28:5893-5909. [PMID: 36405107 PMCID: PMC9669830 DOI: 10.3748/wjg.v28.i41.5893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/17/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
Lichen planus (LP) is a frequent, chronic inflammatory disease involving the skin, mucous membranes and/or skin appendages. Esophageal involvement in lichen planus (ELP) is a clinically important albeit underdiagnosed inflammatory condition. This narrative review aims to give an overview of the current knowledge on ELP, its prevalence, pathogenesis, clinical manifestation, diagnostic criteria, and therapeutic options in order to provide support in clinical management. Studies on ELP were collected using PubMed/Medline. Relevant clinical and therapeutical characteristics from published patient cohorts including our own cohort were extracted and summarized. ELP mainly affects middle-aged women. The principal symptom is dysphagia. However, asymptomatic cases despite progressed macroscopic esophageal lesions may occur. The pathogenesis is unknown, however an immune-mediated mechanism is probable. Endoscopically, ELP is characterized by mucosal denudation and tearing, trachealization, and hyperkeratosis. Scarring esophageal stenosis may occur in chronic courses. Histologic findings include mucosal detachment, T-lymphocytic infiltrations, epithelial apoptosis (Civatte bodies), dyskeratosis, and hyperkeratosis. Direct immuno-fluorescence shows fibrinogen deposits along the basement membrane zone. To date, there is no established therapy. However, treatment with topical steroids induces symptomatic and histologic improvement in two thirds of ELP patients in general. More severe cases may require therapy with immunosuppressors. In symptomatic esophageal stenosis, endoscopic dilation may be necessary. ELP may be regarded as a precancerous condition as transition to squamous cell carcinoma has been documented in literature. ELP is an underdiagnosed yet clinically important differential diagnosis for patients with unclear dysphagia or esophagitis. Timely diagnosis and therapy might prevent potential sequelae such as esophageal stenosis or development of invasive squamous cell carcinoma. Further studies are needed to gain more knowledge about the pathogenesis and treatment options.
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Affiliation(s)
- Annegrit Decker
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
| | - Franziska Schauer
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79104, Germany
| | - Adhara Lazaro
- Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
| | - Carmen Monasterio
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
| | - Arthur Robert Schmidt
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
| | - Annette Schmitt-Graeff
- Institute for Dermatohistology, Pathology, and Molecular Pathology Prof. Dr. Laaf, Freiburg, Germany and: University of Freiburg, Freiburg 79106, Germany
| | - Wolfgang Kreisel
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
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5
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Demystifying Esophageal Lichen Planus: A Comprehensive Review of a Rare Disease You Will See in Practice. Am J Gastroenterol 2022; 117:70-77. [PMID: 34591036 DOI: 10.14309/ajg.0000000000001485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
Lichen planus (LP) is a chronic inflammatory disorder that often affects the skin, hair, nails, and mucus membranes. Although esophageal involvement has traditionally been felt to be rare, recent reports suggest that it is often unrecognized or misdiagnosed. The diagnoses of esophageal lichen planus can be challenging and is suspected based on patients' endoscopic and histologic findings and in the context of their clinical history and physical examination. Physicians must have an index of suspicion, particularly in older white women and in those patients with an atypical esophagitis or stricturing disease, which do not respond to traditional treatment. Currently, there are limited data on esophageal lichen planus patients, and no formal management guidelines for this disease, which all gastroenterologists will see in practice. This article reviews the etiology and histopathology of LP and provides a comprehensive discussion of the clinical features, diagnosis, and management of esophageal disease from the gastroenterologist's perspective. Finally, we address the esophageal complications of LP.
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6
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Malone V, Sheahan K. Novel and rare forms of oesophagitis. Histopathology 2020; 78:4-17. [PMID: 33382498 DOI: 10.1111/his.14284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022]
Abstract
Our understanding of inflammatory diseases of the gastrointestinal tract, including those of the oesophagus, has expanded in recent years. Once attributed almost exclusively to gastro-oesophageal reflux disease or infection, it is now recognised that oesophagitis may occur due to a variety of distinct disease entities. Many of these conditions cause debilitating and persistent symptoms, impacting upon quality of life and necessitating ongoing surveillance and treatment. This review will consider the clinical, endoscopic and histopathological features of these novel and rare forms of oesophagitis.
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Affiliation(s)
- Victoria Malone
- Department of Histopathology, St Vincent's University Hospital, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Kieran Sheahan
- Department of Histopathology, St Vincent's University Hospital, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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7
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Rosic Despalatovic B, Bratanic A, Puljiz Z, Bozikovic J. Esophageal Stenosis in a Patient with Lichen Planus. Case Rep Gastroenterol 2019; 13:134-139. [PMID: 31011313 PMCID: PMC6465741 DOI: 10.1159/000498907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/14/2019] [Indexed: 11/23/2022] Open
Abstract
Lichen planus is a chronic, idiopathic disorder which usually affects skin and mucosal surfaces. While oral mucosa is frequently involved, esophageal localization is uncommon, and it usually manifests with dysphagia. It has also been associated with squamous cell carcinoma. Underdiagnosing of esophageal lichen planus often leads to a delay in treatment. There are also no clear recommendations for treatment of this disorder. Systemic corticosteroids are usually the first-line therapy, but different other therapeutic approaches are also used, with a various rate of response. We present the case of a patient with esophageal lichen planus complicated with esophageal stenosis, who was rather resistant to treatment.
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Affiliation(s)
| | - Andre Bratanic
- Department of Gastroenterology and Hepatology, Split, Croatia
| | - Zeljko Puljiz
- Department of Gastroenterology and Hepatology, Split, Croatia
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8
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Sato Y, Takenaka R, Matsumi A, Takei K, Okanoue S, Yasutomi E, Kawai D, Takemoto K, Tsugeno H, Miyake T, Fujiki S. A Japanese Case of Esophageal Lichen Planus that Was Successfully Treated with Systemic Corticosteroids. Intern Med 2018; 57:25-29. [PMID: 29021479 PMCID: PMC5799052 DOI: 10.2169/internalmedicine.8668-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Esophageal lichen planus (ELP) is rare and only about 80 cases have been reported in the literature. An 85-year-old woman presented with dysphagia and odynophagia. Endoscopy revealed a severe stricture in the proximal esophagus. Oral examinations at two years after the first endoscopy revealed erosions around the gingiva, and an examination of biopsy specimens taken from the site of erosion led to a diagnosis of oral lichen planus. Esophageal endoscopy was performed again, and biopsy specimens showed spongiosis and necrotic keratinocytes in the epithelium (civatte bodies). The patient was diagnosed with ELP and was treated with systemic corticosteroids, which resulted in clinical relief.
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Affiliation(s)
- Yuki Sato
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | - Akihiro Matsumi
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | - Kensuke Takei
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | - Shotaro Okanoue
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | - Eriko Yasutomi
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | - Daisuke Kawai
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | - Koji Takemoto
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | | | - Takayoshi Miyake
- Department of Clinical Laboratory, Pathology Division, Tsuyama Chuo Hospital, Japan
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9
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Teixeira C, Alves AL, Cremers I. Esophageal lichen planus: a rare case. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 110:67-68. [PMID: 29168645 DOI: 10.17235/reed.2017.5332/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lichen planus is a rare, idiopathic disease that usually involves the skin and mucosae. Oral lesions occur in two thirds of cases and may occur without skin involvement. Esophageal lichen planus occur more frequently in middle-age women, it is frequently asymptomatic but may cause odynophagia and dysphagia. Esophageal lichen planus has been associated with squamous cell carcinoma. The most effective treatment is systemic corticotherapy, but relapse is expected in 85% with steroid withdrawal. We present the case of esophageal lichen planus in a 50-year-old man.
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10
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Abstract
OBJECTIVE The purpose of this study is to present the clinical and radiographic findings of esophageal lichen planus. MATERIALS AND METHODS A search of computerized medical records identified 15 patients with pathologic findings of esophageal lichen planus on endoscopic biopsy specimens. Three other patients had presumed esophageal lichen planus, although no biopsy specimens were obtained. Twelve of these 18 patients (67%) had double-contrast esophagography performed at our institution; for eight of the 12 patients (67%), the studies revealed abnormalities in the esophagus. These eight patients constituted our study group. The barium esophagrams and medical records of these eight patients were reviewed to determine the clinical, radiographic, and endoscopic findings of esophageal lichen planus as well as the treatment and patient outcome. RESULTS All eight patients were women (median age, 66.5 years), and all eight presented with dysphagia (mean duration, 3.2 years). Four patients had previous lichen planus that involved the skin (n = 1), the oral cavity (n = 2), or both (n = 1), and one patient later had lichen planus that involved the vagina. Five patients had a small-caliber esophagus with diffuse esophageal narrowing. The remaining three patients had segmental strictures in the cervical (n = 1), upper thoracic (n = 1), and distal thoracic (n = 1) esophagus. CONCLUSION Esophageal lichen planus typically occurs in older women with longstanding dysphagia and often develops in the absence of extraesophageal disease. Barium esophagrams may reveal a small-caliber esophagus or, less commonly, segmental esophageal strictures. Greater awareness of the radiographic findings of esophageal lichen planus hopefully will lead to earlier diagnosis and better management of this condition.
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11
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Akbar T, Al Badri A, Gordon JN. A 50-year-old woman with a recurrent oesophageal stricture. Gut 2016; 65:615, 646. [PMID: 26515542 DOI: 10.1136/gutjnl-2015-310384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/11/2015] [Indexed: 12/08/2022]
Affiliation(s)
- Tahir Akbar
- Department of Gastroenterology, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Adnan Al Badri
- Department of Histopathology, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - John N Gordon
- Department of Gastroenterology, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
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12
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Treatment of esophageal stricture due to lichen planus with intralesional corticosteroid injection. Surg Laparosc Endosc Percutan Tech 2014; 24:e32-4. [PMID: 24487173 DOI: 10.1097/sle.0b013e31828e3f37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Herein we presented a male patient with esophageal stricture due to lichen planus successfully treated with repeated injections of intralesional triamcinolone and review the current literature on esophageal lichen planus with special emphasis on its treatment.
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13
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Linton MS, Zhao L, Gui X, Storr M, Andrews CN. Lichen planus is an uncommon cause of nonspecific proximal esophageal inflammation. Gut Liver 2013; 7:401-5. [PMID: 23898378 PMCID: PMC3724026 DOI: 10.5009/gnl.2013.7.4.401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/05/2012] [Indexed: 01/11/2023] Open
Abstract
Background/Aims Esophageal lichen planus (LP) has been described as a cause of nonspecific esophagitis that may cause dysphagia, but its incidence is unknown. We aimed to estimate the incidence of esophageal LP in a defined geographic region and describe the clinical characteristics of affected patients. Methods A histopathology database for a population of 1 million people was searched for all esophageal mucosal biopsy results over an 8-year period. Cases showing inflammation or abnormalities without a diagnosis after three or more biopsies were reviewed for findings of LP. Results Of 13,589 esophageal biopsies, only one received a diagnosis of LP. Seven patients (four male; mean age, 59 years; range, 39 to 76 years) were identified as having chronic dysphagia and nonspecific proximal esophagitis for which no diagnosis could be made. All patients had proximal inflammation, and six of seven had full-thickness lymphocytic infiltration. Elongation of the lamina propria papillae was noted in all patients, whereas six patients had parakeratosis and ballooning. Only one patient had findings potentially consistent with, but not sufficient for, a diagnosis of esophageal LP. Conclusions Esophageal LP appears to be extremely uncommon in this North American population, and esophageal biopsy alone is likely not sufficient to establish a diagnosis of LP.
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Affiliation(s)
- Matthew S Linton
- Centre for Digestive Motility, Division of Gastroenterology, Department of Medicine, University of Calgary Faculty of Medicine, Calgary, AB, Canada
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14
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Ynson ML, Forouhar F, Vaziri H. Case report and review of esophageal lichen planus treated with fluticasone. World J Gastroenterol 2013; 19:1652-1656. [PMID: 23539434 PMCID: PMC3602484 DOI: 10.3748/wjg.v19.i10.1652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/08/2012] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
Lichen planus is a fairly common chronic idiopathic disorder of the skin, nails and mucosal surfaces. Esophageal involvement of this disease on the other hand is rare and only about 50 cases have been reported in literature. Given its rarity, it can be difficult to diagnose and may be easily misdiagnosed as reflux esophagitis. Currently, there are no clear recommendations on the optimal management of this disease and little is known about the best treatment approach. Systemic steroids are usually the first line treatment and offer a favorable response. In this report, we would like to present a novel approach in the management of esophageal lichen planus in a middle-aged woman treated successfully with swallowed fluticasone propionate 220 mcg twice a day for 6 wk, as evidenced by objective clinical findings. Based on our review of related literature and experience in this patient, we feel that a trial of swallowed fluticasone may be a prudent approach in the management of these patients since it has a more favorable side effect profile than systemic treatment.
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15
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Hou JK, Qureshi W. Swallowed fluticasone for the treatment of esophageal lichen planus. Gastrointest Endosc 2011; 74:708-9. [PMID: 21092955 DOI: 10.1016/j.gie.2010.09.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 09/21/2010] [Indexed: 12/20/2022]
Affiliation(s)
- Jason K Hou
- Baylor College of Medicine, 1709 Dryden Road, Suite 8.40, Houston, TX 77030, USA
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16
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Fox LP, Lightdale CJ, Grossman ME. Lichen planus of the esophagus: what dermatologists need to know. J Am Acad Dermatol 2011; 65:175-83. [PMID: 21536343 DOI: 10.1016/j.jaad.2010.03.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 03/20/2010] [Accepted: 03/29/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Esophageal lichen planus (ELP) is a rare manifestation of mucocutaneous lichen planus (LP). OBJECTIVES We aimed to report our experience and review all cases of ELP reported in the English-language literature. METHODS We report our experience with 4 cases and reviewed PubMed for reports of ELP. Cases were evaluated for age of onset, sex, location of LP, relationship of the onset of ELP to extra-ELP, endoscopic findings, whether biopsy was performed, histopathology of esophageal biopsy specimens, medical history (including gastrointestinal history), development of esophageal squamous cell carcinoma, therapies tried, and response to treatment. RESULTS A total of 72 cases of ELP were studied. In all, 87% of patients were female, with a median age of 61.9 years at time of diagnosis. Dysphagia was present in 81% and odynophagia was present in 24%. Oral LP was present in 89%, anogenital/vulvar LP in 42%, and cutaneous LP in 38%. Fourteen patients developed ELP as the sole or first manifestation of LP. Proximal esophageal lesions were present in 64%, distal in 11%, and both proximal and distal in 26%. Histology was "consistent with" LP in 71%. Four patients developed squamous cell carcinoma in association with ELP. LIMITATIONS This is a review of our cases and others reported in the literature. CONCLUSIONS ELP is underrecognized and underreported. There is often a significant delay between the onset of symptoms and the diagnosis. Malignant transformation of ELP to squamous cell carcinoma has been reported.
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Affiliation(s)
- Lindy Peta Fox
- Department of Dermatology, University of California, San Francisco, California 94115, USA.
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17
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Donnellan F, Swan MP, May GR, Kandel G, Marcon NE, Kortan PP. Fluticasone propionate for treatment of esophageal lichen planus. A case series. Dis Esophagus 2011; 24:211-4. [PMID: 20946136 DOI: 10.1111/j.1442-2050.2010.01120.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal lichen planus is a rare condition, and although the majority of cases occur in conjunction with lichen planus at other sites, the endoscopic features are often misinterpreted resulting in a delay in diagnosis. We report a series of five patients presenting to our unit between 2005 and 2009. All five patients were female and presented with dysphagia. Endoscopy demonstrated proximal esophageal stricturing in four patients. Characteristic histological findings were found in four patients. Lichen planus was diagnosed at other sites, and preceded gastrointestinal symptoms, in all patients; five had oral involvement, two had genital involvement, and one had dermal involvement. All patients received proton pump inhibitor therapy without demonstrable benefit. Administration of oral fluticasone proprionate resulted in symptomatic improvement in three patients.
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Affiliation(s)
- F Donnellan
- Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Canada.
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