Swallowed fluticasone for the treatment of esophageal lichen planus

Hou, Jason K.; Qureshi, Waqar

doi:10.1016/j.gie.2010.09.032

Cited by 16 publications

(10 citation statements)

References 7 publications

(13 reference statements)

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“…However, the relapse rate after steroid withdrawal can be as high as 85% ( 16 ). Recently, fluticasone propionate (220 μg twice daily, topically) was shown to result in clinical and endoscopic improvement ( 3 , 10 , 17 , 18 ). This treatment has the advantage of being associated with fewer side effects in comparison to systematic corticosteroid treatment.…”

Section: Discussionmentioning

confidence: 99%

A Japanese Case of Esophageal Lichen Planus that Was Successfully Treated with Systemic Corticosteroids

et al. 2018

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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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Section: Discussionmentioning

confidence: 99%

A Japanese Case of Esophageal Lichen Planus that Was Successfully Treated with Systemic Corticosteroids

et al. 2018

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“…ELP was regarded then as a rarity, likely because its clinical, endoscopic, and histologic features were not yet clearly understood. In recent years, interest about this “new” disease was growing and consequently, larger case series and studies[ 16 - 20 , 58 , 60 , 65 - 69 ],as well as two comprehensive reviews were published[ 70 , 71 ]. For this narrative review, studies were collected using PubMed/Medline and single case reports were excluded.…”

Section: Main Bodymentioning

confidence: 99%

Esophageal lichen planus: Current knowledge, challenges and future perspectives

Decker¹,

Schauer²,

Lazaro³

et al. 2022

World J Gastroenterol

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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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“…Eine Manifestation des Lichen planus im Ösophagus wurde erstmals 1982 [24,25] und dann wieder in der ersten Dekade dieses Jahrhunderts in Einzelfallberichten oder kleinen Fallserien beschrieben [26][27][28][29][30][31][32][33][34][35]. Erst in den letzten etwa 10 Jahren wurden Berichte über größere Fallzahlen oder systematische Studien publiziert, und das Interesse an dieser bisher wenig beachteten, als Rarität angesehenen Erkrankung nahm zu [7][8][9][10][11][34][35][36].…”

Section: Der öSophageale Lichen Planus (Elp)unclassified

Der Lichen planus des Ösophagus – Eine unterschätzte Erkrankung

et al. 2021

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ZusammenfassungEine Beteiligung des Ösophagus bei der Hauterkrankung Lichen planus wurde erstmals 1982 beschrieben und fast 30 Jahre lang als eine Rarität angesehen. Untersuchungen der letzten 10 Jahre aber zeigen, dass diese Erkrankung weniger selten ist als angenommen. Es ist sogar anzunehmen, dass der ösophageale Lichen planus (Esophageal Lichen planus, ELP) häufiger ist als die Eosinophile Ösophagitis (EoE). Die Ösophagusbeteiligung betrifft meist Frauen im mittleren Alter. Das Hauptsymptom ist eine Dysphagie. Endoskopisch erkennt man in der Speiseröhre eine charakteristische Schleimhautablösung, eine Trachealisierung, und gelegentlich Hyperkeratosen und bei langem Bestehen auch Stenosen. Wegweisend ist die Histologie mit einer subepithelialen Ablösung sowie einem bandförmigen Infiltrat aus T-Lymphozyten, dem Nachweis von apoptotischen Keratinozyten (Civatte Bodies) und Dyskeratosen. Die direkte Immunfluoreszenz zeigt Fibrinogen-Ablagerungen entlang der Basalmembran. Eine etablierte Therapie gibt es bisher nicht. Die Behandlung mit topischen Steroiden ist in 2/3 der Fälle wirksam. Eine Therapie wie beim klassischen Lichen planus scheint unwirksam zu sein. Bei symptomatischen Stenosen kann eine Dilatation indiziert sein. Der ELP reiht sich in die Gruppe der „neuen“ immunologisch vermittelten Erkrankungen des Ösophagus ein.

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Swallowed fluticasone for the treatment of esophageal lichen planus

Cited by 16 publications

References 7 publications

A Japanese Case of Esophageal Lichen Planus that Was Successfully Treated with Systemic Corticosteroids

A Japanese Case of Esophageal Lichen Planus that Was Successfully Treated with Systemic Corticosteroids

Esophageal lichen planus: Current knowledge, challenges and future perspectives

Der Lichen planus des Ösophagus – Eine unterschätzte Erkrankung

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