Lichen planus of the esophagus mimicking peptic stricture

Abstract

This report describes an elderly woman referred to our institution for evaluation of refractory peptic stricture and consideration of anti-reflux surgery. A 66-year-old white woman presented with recurrent esophageal dysphagia to solids for four years. She denied weight loss, reflux-type symptoms, and odynophagia. There was no history of lye ingestion or use of medication causing esophagitis. Her gastroenterologist treated her for acid reflux with sucralfate, omeprazole, and cisapride, and performed multiple esophageal dilatations. A 24-hour pH monitoring off omeprazole showed normal acid exposure. Esophageal motility was normal except for hypertensive lower esophageal sphincter. Upper endoscopy revealed desquamating esophagitis involving most of the esophagus. No obvious stricture was noted. Biopsies of the esophagus revealed severe inflammation with squamous mucosa separation from the submucosa consistent with LP. Cultures and stains for viruses and fungi were negative. Following the above testing, the patient admitted to a history of recurrent gingival LP. She suffered from dyspareunia and recurrent vaginitis for two years. Examination of the oral cavity revealed mildly erythematous lesions in the periodontal areas. Pelvic exam showed narrowed vagina with fusion of anterior and posterior walls suggestive of LP. A skin biopsy of a raised erythematous patch on the trunk confirmed diagnosis of LP. Endiscopic follow-up two months later revealed multiple ring-type esophageal strictures, which were succesfully dilated. Treatment with oral steroids was initiated. At the six-month follow-up, the patient noticed significant improvement in her dysphagia.