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Girish MI, Dahale AS, Banerjee D, Jillawar N, Bhate P. Esophageal Lichen Planus Unusual Presentations: A Case Series. Indian J Otolaryngol Head Neck Surg 2023; 75:2260-2262. [PMID: 37636730 PMCID: PMC10447717 DOI: 10.1007/s12070-022-03244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/11/2022] [Indexed: 02/16/2023] Open
Abstract
Esophageal Lichen Planus (ELP)is a rare manifestation of Lichen Planus(LP). We present a case series of 2 patients with oral mucosal involvement who presented with dysphagia. On endoscopy, one patient revealed proximal esophageal stricture and the other patient had proximal esophageal ulcer. LP considered as a differential diagnosis in middle aged women with dysphagia.
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Affiliation(s)
| | - Amol S. Dahale
- Department of Gastroenterology and Hepatology, DY Patil Medical College, Pune, India
| | - Debabrata Banerjee
- Department of Gastroenterology and Hepatology, DY Patil Medical College, Pune, India
| | - Nikhil Jillawar
- Department of Surgical Gastroenterology, DY Patil Medical College , Pune, India
| | - Prasad Bhate
- Department of Gastroenterology and Hepatology, DY Patil Medical College, Pune, India
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2
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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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3
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McDermott E, Solomon N, Silva AM, Khoshpouri P. Lichen Planus. Radiographics 2023; 43:e220200. [PMID: 36927126 DOI: 10.1148/rg.220200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Edward McDermott
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin D07 R2WY, Ireland (E.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (N.S.); Department of Education, Wright State University Boonshoft School of Medicine, Dayton, Ohio (A.M.S.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Md (P.K.)
| | - Nadia Solomon
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin D07 R2WY, Ireland (E.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (N.S.); Department of Education, Wright State University Boonshoft School of Medicine, Dayton, Ohio (A.M.S.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Md (P.K.)
| | - Annelise M Silva
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin D07 R2WY, Ireland (E.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (N.S.); Department of Education, Wright State University Boonshoft School of Medicine, Dayton, Ohio (A.M.S.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Md (P.K.)
| | - Parisa Khoshpouri
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin D07 R2WY, Ireland (E.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (N.S.); Department of Education, Wright State University Boonshoft School of Medicine, Dayton, Ohio (A.M.S.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Md (P.K.)
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4
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Hirapara B, Witheiler D, Tarnasky PR, Villamil M. Esophageal Perforation and Pneumomediastinum Due to Delayed Diagnosis of Esophageal Lichen Planus. Cureus 2023; 15:e35453. [PMID: 36994252 PMCID: PMC10042273 DOI: 10.7759/cureus.35453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
Esophageal involvement of lichen planus is an under-reported and under-diagnosed manifestation that should prompt immediate treatment given its high rate of complications. We highlight a rare case of a 62-year-old Caucasian woman with history of known oral lichen planus and esophageal strictures presumed to be secondary to gastroesophageal reflux disease, that presented with esophageal food impaction resulting in perforation and subsequent pneumomediastinum after esophagogastroduodenoscopy (EGD). Further workup, including a repeat EGD, revealed that the esophageal strictures were rather a complication of lichen planus. The patient was started on oral, topical steroids and underwent serial esophageal dilations with improvement. Esophageal lichen planus should be high on the differential, especially in patients with involvement of other mucous membranes and strictures refractory to therapy. Complications such as recurrent esophageal strictures and perforation may be preventable with early diagnosis and adequate treatment.
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5
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Muacevic A, Adler JR, Liu SS, Dasaraju S. Pityriasis Lichenoides Chronica of Esophagus: A Rare Case Report. Cureus 2022; 14:e32290. [PMID: 36628008 PMCID: PMC9819751 DOI: 10.7759/cureus.32290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 12/13/2022] Open
Abstract
Pityriasis lichenoides chronica (PLC) is an uncommon inflammatory skin condition of unknown cause that ranges from a mild chronic form to a more severe acute eruption. Both forms usually involve the skin of the trunk and proximal extremities, and visceral involvement is not a well-described phenomenon. Here, we report a case of PLC that presented with esophageal involvement that occurred after a period of discontinuation of PLC treatment. The histological pattern of involvement is in the form of lymphocytic esophagitis, a non-specific pattern with a broad differential diagnosis. Awareness of the potential involvement of the esophagus and attention to certain endoscopic and morphological details may better help classify esophagitis biopsies and the diagnosis of this rare non-neoplastic chronic inflammatory disease. To our knowledge, this is the first-ever case of PLC with esophageal involvement, and nothing has been reported in the English literature earlier.
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6
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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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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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8
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Treatment of esophageal stricture due to lichen planus with intralesional triamcinolone injection. Eur J Gastroenterol Hepatol 2021; 33:1611. [PMID: 34723875 DOI: 10.1097/meg.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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9
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Lu CY, Hsieh MS, Wei KC, Ezmerli M, Kuo CH, Chen W. Gastrointestinal involvement of primary skin diseases. J Eur Acad Dermatol Venereol 2020; 34:2766-2774. [PMID: 32455473 DOI: 10.1111/jdv.16676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
Less is known about gastrointestinal (GI) involvement of primary skin diseases due to the difference in embryology, histology, microbiology and physiology between integument and alimentary tract. Oesophagus, following the oropharyngeal mucosa, is the most common GI segment affected by primary skin diseases, especially by eosinophilic oesophagitis, lichen planus and autoimmune bullous dermatoses like pemphigus vulgaris, mucosal membrane pemphigoid and epidermolysis bullosa acquisita. Eosinophilic oesophagitis is an emerging chronic atopic disease with oesophageal dysfunction as the typical presentation, and oesophageal narrowing, rings and stricture as late complications. Oesophageal lichen planus mainly involves the proximal to mid-oesophagus in elderly aged women with long-term oral mucosal lesions. In acute attack of pemphigus vulgaris, oesophageal involvement is not uncommon but often neglected and may cause sloughing oesophagitis (oesophagitis dissecans superficialis) with acute GI bleeding in rare cases. GI manifestation of hereditary bradykininergic angio-oedema with colicky acute abdomen mostly affects small intestine, usually in the absence of pruritus or urticaria, and is more severe and long-lasting than the acquired histaminergic form. Strong evidence supports association between inflammatory bowel disease, especially Crohn disease, and hidradenitis suppurativa/acne inversa. Patients with vitiligo need surveillance of autoimmune liver disease, autoimmune atrophic gastritis or coeliac disease when corresponding symptoms become suspect. Melanoma is the most common primary tumour metastatic to the GI tract, with small intestine predominantly targeted. Gastrointestinal involvement is not uncommon in disseminated mycosis fungoides. Extramammary Paget's disease is an intraepidermal adenocarcinoma of controversial origin, and a high association between the anogenital occurrence and colorectal adenocarcinoma has been reported. As GI tract is the largest organ system with multidimensional functions, dermatologists in daily practice should be aware of the gastrointestinal morbidities related to primary skin diseases for an early diagnosis and treatment.
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Affiliation(s)
- C-Y Lu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M-S Hsieh
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - K-C Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - M Ezmerli
- Department of Dermatology, Faculty of Medicine in Rabigh, Kingdom of Saudi Arabia, King Abdulaziz University, Jeddah, Saudi Arabia
| | - C-H Kuo
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - W Chen
- Center for Research & Development, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.,Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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10
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Arshad T, Fleckenstein K, Sardana N, Scudera PL. No lesion? No problem: case of oesophageal lichen planus in a patient without any cutaneous lesions. BMJ Case Rep 2020; 13:13/3/e232375. [PMID: 32188605 DOI: 10.1136/bcr-2019-232375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oesophageal lichen planus (ELP) is an uncommon presentation of mucocutaneous lichen planus. Due to its rare nature, it can often be misdiagnosed. As such, there can be a significant delay between symptom onset and diagnosis. ELP drastically reduces quality of life secondary to the severe dysphagia and odynophagia that typically accompany this pathogenesis. Additionally, it is important to diagnose ELP in a timely manner as ELP increases the risk of squamous cell carcinoma, with reported cases of malignant transformation. More research is needed on ELP with regard to diagnostic criteria and evidence-based therapeutic recommendations.
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Affiliation(s)
- Tamoore Arshad
- Internal Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Katarina Fleckenstein
- Internal Medicine, Virginia Commonwealth University School of Medicine, Falls Church, Virginia, USA
| | - Nitin Sardana
- Gastroenterology, Gastroenterology Associates of Northern Virginia, Fairfax, Virginia, USA
| | - Peter L Scudera
- Gastroenterology, Gastroenterology Associates of Northern Virginia, Fairfax, Virginia, USA
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11
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Rai P, Madi MY, Lee R, Dickstein A. A Case Series of Esophageal Lichen Planus: An Underdiagnosed Cause of Dysphagia. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2019. [DOI: 10.7704/kjhugr.2019.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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Sethi K, Hoque S. An interesting pill to swallow. Frontline Gastroenterol 2019; 12:357-358. [PMID: 34249326 PMCID: PMC8231422 DOI: 10.1136/flgastro-2019-101342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Karishma Sethi
- Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sami Hoque
- Gastroenterology, Barts Health NHS Trust, London, UK
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13
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Thomas AS, Ro JY, Ergun GA. "Doctor, I Just Can't Seem to Swallow!". Gastroenterology 2019; 157:938-939. [PMID: 31158370 DOI: 10.1053/j.gastro.2019.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/02/2022]
Affiliation(s)
| | - Jae Y Ro
- Houston Methodist hospital, Houston, Texas
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14
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Zamani F, Haghighi M, Roshani M, Sohrabi M. Esophageal Lichen Planus Stricture. Middle East J Dig Dis 2019; 11:52-54. [PMID: 31049183 PMCID: PMC6488495 DOI: 10.15171/mejdd.2018.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/11/2018] [Indexed: 12/19/2022] Open
Abstract
Lichen planus is a dermatologic chronic inflammatory disease that usually involved the skin and mucosa. Esophageal lichen planus with stricture is rare presentation of this disease. It is usually associated with oral mucosal involvement and commonly presenting in middle-age female. In present case, we describe a 48-year-old woman with history of oral lichen planus who referred to us for progressive dysphagia for solid food .She had not history of other causes of dysphagia. Upper endoscopy revealed a benign stricture located in proximal of esophagus that comparable with lichen planus features. The patient underwent three sessions of wireguided bougie dilation that improved her symptoms totally. Lichen planus has to be considered in differential diagnosis in patients with dysphagia.
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Affiliation(s)
- Farhad Zamani
- Gastroenterology and Liver Disease Research Center, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Ira
| | - Mehran Haghighi
- Gastroenterology and Liver Disease Research Center, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Ira
| | - Mohammad Roshani
- Gastroenterology and Liver Disease Research Center, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Ira
| | - Masoudreza Sohrabi
- Gastroenterology and Liver Disease Research Center, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Ira
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15
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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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Carbonari APC, Imada RR, Nakamura R, Araki O, Cristina K, Balancin ML, Ibrahim RE. Esophageal lichen planus: An unusual cause of dysphagia in the elderly. ACTA ACUST UNITED AC 2018; 64:214-216. [PMID: 29641782 DOI: 10.1590/1806-9282.64.03.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/15/2017] [Indexed: 11/22/2022]
Abstract
An 82-year-old man sought our service with dysphagia and was referred for upper endoscopy with biopsies, which evidenced multiple ulcers of the esophagus and oropharinx. Histopathology confirmed the unusual diagnosis of esophageal lichen planus. The correct clinical suspicion of this disease can facilitate the diagnosis and guide specific treatment, which can drastically change the natural course of the disease.
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Affiliation(s)
| | - Regina Rie Imada
- Endoscopy Unit, Rede D'Or Hospital São Luiz - Unidade Itaim, São Paulo, SP, Brazil
| | - Romeu Nakamura
- Endoscopy Unit, Rede D'Or Hospital São Luiz - Unidade Itaim, São Paulo, SP, Brazil
| | - Osvaldo Araki
- Endoscopy Unit, Rede D'Or Hospital São Luiz - Unidade Itaim, São Paulo, SP, Brazil
| | - Kelly Cristina
- Endoscopy Unit, Rede D'Or Hospital São Luiz - Unidade Itaim, São Paulo, SP, Brazil
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17
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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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18
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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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19
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Esophageal Lichen Planus: Understanding a Potentially Severe Stricturing Disease. Case Rep Gastrointest Med 2017; 2017:5480562. [PMID: 29109874 PMCID: PMC5646309 DOI: 10.1155/2017/5480562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/20/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022] Open
Abstract
A 67-year-old woman with a long-standing history of recurrent dysphagia and esophageal strictures failed to respond to aggressive antireflux management. She required multiple dilations for symptomatic strictures that were discovered throughout the esophagus. Intralesional, topical, and systemic glucocorticoid therapies were utilized without resolution in symptoms. Several years after initial presentation, histopathology ultimately demonstrated lichenoid features and a diagnosis of esophageal lichen planus (ELP) was confirmed. However, as her symptoms had already become significantly disabling with severe strictures that carried an increased risk of endoscopic complications with dilation, she ultimately decided to undergo an esophagectomy for definitive treatment. Moreover, ELP may often go unrecognized for several years. Clinicians should consider ELP in the differential for dysphagia in middle- to elderly-aged women with or without a known history of lichen planus (LP) especially for those with findings of multiple or proximal strictures.
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Podboy A, Sunjaya D, Smyrk TC, Murray JA, Binder M, Katzka DA, Alexander JA, Halland M. Oesophageal lichen planus: the efficacy of topical steroid-based therapies. Aliment Pharmacol Ther 2017; 45:310-318. [PMID: 27859412 DOI: 10.1111/apt.13856] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 08/26/2016] [Accepted: 10/15/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Oesophageal lichen planus is an idiopathic inflammatory disorder characterized by significant oesophageal stricturing. Oesophageal lichen planus is a rare, difficult to diagnose, and likely an under recognized disease. As a result, there is no standardized approach to therapy and treatment strategies vary. AIM To examine the utility of topical steroid therapy (fluticasone or budesonide) in the management of oesophageal lichen planus. METHODS A retrospective chart review was conducted of patients diagnosed with oesophageal lichen planus who underwent baseline and follow up endoscopy pre and post topical steroid therapy between 1995 and 2016 at Mayo Clinic, Rochester MN. Average time between upper GI endoscopy was 3.2 months (0.7-11.7). Swallowed steroid preparations included fluticasone 880 μg twice daily or budesonide 3 mg twice daily. Patients were reviewed for symptomatic response to therapy using the Dakkak-Bennett dysphagia score (0-4, no dysphagia to total aphagia). Pre- and post-endoscopic findings were assessed. Additional baseline demographic, endoscopic, and histologic data were also obtained. RESULTS We identified 40 patients who met the inclusion criteria. A significant reduction in median dysphagia score from 1 (0-4) to 0 (0-3) after steroid therapy (P < 0.001) was noted. 62% of patients reported resolution of their dysphagia after receiving topical corticosteroids. 72.5% had an endoscopic response to steroid therapy. CONCLUSION Topical swallowed budesonide or fluticasone appear to effective treatment for oesophageal lichen planus.
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Affiliation(s)
- A Podboy
- Division of Internal Medicine and Graduate Medical Education, Mayo Clinic, Rochester, MN, USA
| | - D Sunjaya
- Division of Internal Medicine and Graduate Medical Education, Mayo Clinic, Rochester, MN, USA
| | - T C Smyrk
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - J A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - M Binder
- Division of Internal Medicine and Graduate Medical Education, Mayo Clinic, Rochester, MN, USA
| | - D A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - J A Alexander
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - M Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Esophageal involvement is frequent in lichen planus: study in 32 patients with suggestion of clinicopathologic diagnostic criteria and therapeutic implications. Eur J Gastroenterol Hepatol 2016; 28:1374-1382. [PMID: 27580215 DOI: 10.1097/meg.0000000000000732] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Lichen planus (LP) is a classic skin disease that can involve the skin, hair, and nails, as well as the oral and genital mucosa. Histopathology is characterized by a T-lymphocytic, lichenoid, and interface dermatitis. Multiple case reports and small case series have shown that LP can involve the esophagus. However, the diagnostic criteria, incidence, and best treatment options remain uncertain. This study aimed to refine the diagnostic criteria, estimate prevalence, and present an outlook on treatment options to prevent long-term sequelae. PATIENTS AND METHODS Thirty-two consecutive patients with LP of the skin, hair, nails, oral mucosa, and/or genital mucosa underwent a comprehensive clinicopathologic assessment. Esophagogastroduodenoscopy was performed, and biopsies were evaluated histologically, immunohistochemically, and by direct immunofluorescence. Patients diagnosed with esophageal lichen planus (ELP) were followed up prospectively where possible. RESULTS In total, 20 of 32 patients had ELP. Ten of these 20 patients were classified as having proven ELP, with clear-cut endoscopically visible lesions; the other 10 were classified as having probable ELP. Eight of 10 patients with proven ELP were started on new or additional therapy because of esophageal findings. Treatment with a topical budesonide formulation or systemic corticosteroids was successful in most patients with proven ELP and reversed functional esophageal stenosis. CONCLUSION ELP can be found in more than 50% of patients with proven mucocutaneous LP when clinical and pathologic findings are correlated carefully. Topical or systemic corticosteroids are the first-line therapy for ELP. Timely medical therapy seems to prevent scarring stenosis of the esophagus.
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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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