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(41): 5893-5909 [PMID: 36405107 DOI: 10.3748/wjg.v28.i41.5893]
Corresponding Author of This Article
Wolfgang Kreisel, MD, Emeritus Professor, Department of Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Str. 55, Freiburg 79106, Germany. wolfgang.kreisel@uniklinik-freiburg.de
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 7, 2022; 28(41): 5893-5909 Published online Nov 7, 2022. doi: 10.3748/wjg.v28.i41.5893
Esophageal lichen planus: Current knowledge, challenges and future perspectives
Annegrit Decker, Franziska Schauer, Adhara Lazaro, Carmen Monasterio, Arthur Robert Schmidt, Annette Schmitt-Graeff, Wolfgang Kreisel
Annegrit Decker, Carmen Monasterio, Arthur Robert Schmidt, Wolfgang Kreisel, 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
Annette Schmitt-Graeff, Institute for Dermatohistology, Pathology, and Molecular Pathology Prof. Dr. Laaf, Freiburg, Germany and: University of Freiburg, Freiburg 79106, Germany
Author contributions: Decker A, and Kreisel W designed the manuscript; Schmitt-Graeff A performed the histological evaluation; Schauer F evaluated dermatological findings and performed direct immunofluorescence; All authors collected and interpreted data from patients of their own cohort and from literature; All authors contributed to writing the text. The final stylistic corrections were made by Lazaro A.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wolfgang Kreisel, MD, Emeritus Professor, Department of Medicine II, Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases, Faculty of Medicine, Medical Center-University of Freiburg, Hugstetter Str. 55, Freiburg 79106, Germany. wolfgang.kreisel@uniklinik-freiburg.de
Received: July 28, 2022 Peer-review started: July 28, 2022 First decision: August 31, 2022 Revised: September 17, 2022 Accepted: October 27, 2022 Article in press: October 27, 2022 Published online: November 7, 2022 Processing time: 98 Days and 23.5 Hours
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.
Core Tip: 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 an underdiagnosed inflammatory condition. ELP mainly affects middle-aged women. The principal symptom is dysphagia. Aymptomatic cases may occur. An immune-mediated pathogenesis is probable. Endoscopy shows mucosal denudation and tearing, trachealization, and hyperkeratosis. Scarring esophageal stenosis occurs. Histology includes mucosal detachment, T-lymphocytic infiltrations, epithelial apoptosis, dyskeratosis, and hyperkeratosis. Direct immuno-fluorescence shows fibrinogen deposits along the basement membrane zone. Treatment with topical steroids or immunosuppression may induce symptomatic and histologic improvement. ELP can be regarded as a precancerous condition.
