Lichenoid Esophagitis; Clinical Overlap with Established Esophageal Lichen Planus
Safia N Salaria, Michael W Cruise, Laura D Wood, Elizabeth A Montgomery. Johns Hopkins School of Medicine, Baltimore, MD
Background: Lichen planus (LP) affects mucocutaneous surfaces, and is characterized by intra-epithelial and lamina propria lymphocytosis and squamous cell apoptosis (Civatte bodies). LP esophagitis (LPE) is under recognized; concurrent cutaneous disease is present in some patients, but LPE alone and/or with oral lesions is more common.
Design: We diagnose patients with characteristic pathologic findings of LP esophagitis and known correlation with skin disease or immunofluorescence (IF) results as LPE but use descriptive terminology (“lichenoid esophagitis pattern”/LEP) when confirmation is unavailable. We reviewed clinicopathologic features of cases diagnosed at our institution with LPE or LEP (1/2000 - 8/2012). Immunostains (CD3, CD20, FOXP3) were performed on biopsies from patients with 1) proven LPE, 2) proven LPE and oral LP 3) LPE plus known cutaneous LP, 4) LPE and nonspecific skin changes, and 5) patients with LEP on biopsy, with negative LPE IF studies.
Results: There were 88 specimens with LPE or LEP from 65 patients. Most (79%) patients were female. Seventeen (26%) patients had LPE confirmed by IF. Five (8%) patients had both esophageal (1 with IF) and skin LP.
|Established LPE % (N)||LEP % (N)||p|
|Number of patients||32% (21)||68% (44)|
|Female||95% (20)||71% (31)||0.000001|
|Dysphagia||43% (9)||23% (10)||NS|
|Structures||38% (8)||9% (4)||0.000001|
|Distribution - Med Esophagus||14% (3)||27% (12)||NS|
|Distribution - Upper and Lower Esophagus||33% (7)||18% (8)||NS|
|Associated Rheumatologic Disorders||24% (5)||11% (5)||0.00236|
|HIV||0% (0)||14% (6)||0.00007|
|Viral Hepatitis||0% (0)||9% (4)||<0.05|
|Takin >3 Medications||67% (14)||59% (26)||0.00001|
|Progression to Dysplasia/Carcinoma||5% (1)||7% (3)||NS|