Esophageal lichen planus: towards diagnosis of an underdiagnosed disease

被引:21
作者
Schauer, Franziska [1 ]
Monasterio, Carmen [2 ]
Technau-Hafsi, Kristin [1 ]
Kern, Johannes Steffen [1 ,3 ]
Lazaro, Adhara [4 ]
Deibert, Peter [4 ]
Hasselblatt, Peter [2 ]
Schwacha, Henning [2 ]
Heeg, Steffen [2 ]
Brass, Volker [5 ]
Kuellmer, Armin [2 ]
Schmidt, Arthur Robert [2 ]
Schmitt-Graeff, Annette [6 ]
Kreisel, Wolfgang [2 ]
机构
[1] Univ Freiburg, Fac Med, Med Ctr, Dept Dermatol, Freiburg, Germany
[2] Univ Freiburg, Fac Med, Med Ctr, Dept Med Gastroenterol Hepatol Endocrinol & Infec, D-79106 Freiburg, Germany
[3] Univ Melbourne, Fac Med Dent & Hlth Sci, Royal Melbourne Hosp, Dept Dermatol, Parkville, Vic, Australia
[4] Univ Freiburg, Fac Med, Med Ctr, Dept Med,Inst Exercise & Occupat Med, Freiburg, Germany
[5] Kliniken Landkreises Lorrach GmbH, Lorrach, Germany
[6] Univ Freiburg, Med Ctr, Inst Clin Pathol, Freiburg, Germany
关键词
Lichen planus; esophagus; budenoside; dysphagia; esophagitis; eosinophilic esophagitis; skin disease; autoimmunity; T-cells; BASEMENT-MEMBRANE ZONE; LYMPHOCYTIC ESOPHAGITIS; DISSECANS SUPERFICIALIS; EOSINOPHILIC ESOPHAGITIS; VERRUCOUS CARCINOMA; INVOLVEMENT; DERMATOSES; PREVALENCE; CHALLENGES; PARADIGM;
D O I
10.1080/00365521.2019.1674375
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Although lichen planus (LP) is a common skin disorder, the prevalence of esophageal involvement (ELP) and its clinical manifestations are poorly defined. We aimed to establish diagnostic criteria and characterize disease outcomes of ELP. Methods: Clinical, endoscopic, histological, and immunofluorescence data from consecutive patients with known LP between 2013 and 2018 were analyzed. We established endoscopic (denudation and tearing of the mucosa, hyperkeratosis and trachealization) and histological criteria (mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis, dyskeratosis, and fibrinogen deposits along the basement membrane) to grade disease severity. Endoscopic findings were correlated with clinical symptoms. Response to medical therapy was monitored. Results: Fifty-two consecutive patients (median age 59.5?years) were analyzed. According to our grading system, 16 patients were considered as severe and 18 as mild ELP. Dysphagia was the only symptom which differentiated patients with severe (14/16) or mild ELP (8/18) from patients without ELP (1/18). Concomitant oral and genital involvement of LP was associated with the presence of ELP, while oral involvement alone was not. Follow-up of 14/16 patients with severe EPL for at least one year revealed that most of these patients responded to topical corticosteroids (budesonide: n?=?9/10 or fluticasone n?=?2/2). Three budesonide patients experienced a resolution of symptomatic esophageal stenosis. Conclusions: Esophageal involvement of LP is frequent, but may be asymptomatic. ELP can be diagnosed using the diagnostic criteria proposed here. Dysphagia and combined oral and genital manifestation are associated with ELP. Therapy with topical corticosteroids appears to be a prudent therapeutic approach for ELP.
引用
收藏
页码:1189 / 1198
页数:10
相关论文
共 55 条
[21]   Lymphocytic oesophagitis: clinicopathological aspects of an emerging condition [J].
Haque, Salima ;
Genta, Robert M. .
GUT, 2012, 61 (08) :1108-1114
[22]   Esophagitis Dissecans Superficialis: Clinical, Endoscopic, and Histologic Features [J].
Hart, Phil A. ;
Romano, Ryan C. ;
Moreira, Roger K. ;
Ravi, Karthik ;
Sweetser, Seth .
DIGESTIVE DISEASES AND SCIENCES, 2015, 60 (07) :2049-2057
[23]   Esophagitis dissecans superficialis and autoimmune bullous dermatoses: A review [J].
Hokama, Akira ;
Yamamoto, Yu-ichi ;
Taira, Kiyohito ;
Nakamura, Mitsuteru ;
Kobashigawa, Chiharu ;
Nakamoto, Manabu ;
Hirata, Tetsuo ;
Kinjo, Nagisa ;
Kinjo, Fukunori ;
Takahashi, Kenzo ;
Fujita, Jiro .
WORLD JOURNAL OF GASTROINTESTINAL ENDOSCOPY, 2010, 2 (07) :252-256
[24]   Swallowed fluticasone for the treatment of esophageal lichen planus [J].
Hou, Jason K. ;
Qureshi, Waqar .
GASTROINTESTINAL ENDOSCOPY, 2011, 74 (03) :708-709
[25]   Variations in Presentations of Esophageal Involvement in Lichen Planus [J].
Katzka, David A. ;
Smyrk, Thomas C. ;
Bruce, Alison J. ;
Romero, Yvonne ;
Alexander, Jeffrey A. ;
Murray, Joseph A. .
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2010, 8 (09) :777-782
[26]   Lichen planus esophagitis: report of three patients treated with oral tacrolimus or intraesophageal corticosteroid injections or both [J].
Keate, RF ;
Williams, JW ;
Connolly, SM .
DISEASES OF THE ESOPHAGUS, 2003, 16 (01) :47-53
[27]   Esophageal involvement is frequent in lichen planus: study in 32 patients with suggestion of clinicopathologic diagnostic criteria and therapeutic implications [J].
Kern, Johannes S. ;
Technau-Hafsi, Kristin ;
Schwacha, Henning ;
Kuhlmann, Jan ;
Hirsch, Gunther ;
Brass, Volker ;
Deibert, Peter ;
Schmitt-Graeff, Anette ;
Kreisel, Wolfgang .
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, 2016, 28 (12) :1374-1382
[28]   Diagnosis and classification of pemphigus and bullous pemphigoid [J].
Kershenovich, Ruben ;
Hodak, Emmilia ;
Mimouni, Daniel .
AUTOIMMUNITY REVIEWS, 2014, 13 (4-5) :477-481
[29]   Oral, Esophageal and Cutaneous Lichen Ruber Planus Controlled with Alitretinoin: Case Report and Review of the Literature [J].
Kolios, Antonios G. A. ;
Maggio, Ewerton Marques ;
Gubler, Christoph ;
Cozzio, Antonio ;
Dummer, Reinhard ;
French, Lars E. ;
Navarini, Alexander A. .
DERMATOLOGY, 2013, 226 (04) :302-310
[30]   Lichen Planus [J].
Le Cleach, Laurence ;
Chosidow, Olivier .
NEW ENGLAND JOURNAL OF MEDICINE, 2012, 366 (08) :723-732