Esophageal Lichen Planus: Efficacy of Topical Steroid-Based Therapies: 2016 ACG Presidential Poster Award

Abstract

Introduction: Background & Aims: Esophageal lichen planus (ELP) is an idiopathic inflammatory disorder characterized by significant esophageal stricturing. Esophageal lichen planus is a rare, diffi cult to diagnose, and likely an under recognized disease. Less than 100 cases have been described in case reports and series. As a result, there is no standardized approach to therapy and treatment strategies vary. Approaches which have been used on a case to case basis include steroids (systemic and topical), immunomodulators and endoscopic dilation. Our study examined the utility of topical steroid therapy (fluticasone and budesonide) on the management of esophageal lichen planus in a large cohort of patients. Methods: A retrospective chart review was conducted of patients diagnosed with ELP who underwent baseline and follow up endoscopy pre and post topical steroid therapy between 1995 and 2016 at Mayo Clinic, Rochester MN. Patients were reviewed for symptomatic response to therapy using the Dakkak-Bennett dysphagia score. Pre and post endoscopic findings were assessed. Additional baseline demographic, endoscopic, and histologic data were also obtained. Results: 40 patients met the inclusion criteria. A significant reduction in median dysphagia score from 1 to 0 after steroid therapy (p < 0.001) was noted. 62% of patients reported resolution of their dysphagia after receiving topical corticosteroids. An endoscopic response to steroid therapy was seen in 72.5% on follow up endoscopy. Conclusion: To our knowledge this is the largest study examining the efficacy of topical swallowed budesonide and fluticasone in patients with esophageal lichen planus. Our data suggest that this therapy both positively affects dysphagia as well as mucosal appearance. Adverse events included esophageal candidiasis which affected 10% and responded to therapy in all.Table 1: Characteristics of 40 patients with esophageal lichen planusTable 2: Barium Swallow and Endoscopic FindingsFigure 1Figure 2