Oesophageal involvement in pemphigus vulgaris

Abstract

Hiroko Gomi and co-workers (Nov 20, p 1794)1Gomi H Akiyama M Yakabi K Nakamura T Matsuo I Oesophageal involvement in pemphigus vulgaris.Lancet. 1999; 354: 1794Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar show that oesophageal involvement is common in pemphigus vulgaris. Dermatologists have been aware of this possible involvement in the context of extended buccal erosions and of retrosternal pain after swallowing.2Trattner A Lurie R Leiser A et al.Esophageal involvement in pemphigus vulgaris: a clinical, histologic, and immunopathologic study.J Am Acad Dermatol. 1991; 24: 223-226Summary Full Text PDF PubMed Scopus (51) Google Scholar We usually avoid oesophageal fibroscopy because, first, it is a risky procedure: the extreme fragility of the mucous membranes makes it likely that the fibroscope will aggravate the lesions. In fact, we have observed such an effect on one occasion. Second, there is no specific treatment for oesophageal lesions. This type of patient is usually given high-dose steroids with or without immunosuppressive drugs. I cannot imagine the specific “appropriate treatment of oesophageal lesions” that could be helpful. As far as I am aware, the only appropriate management of such lesions is to avoid trauma. Hiroko Gomi and co-workers (Nov 20, p 1794)1Gomi H Akiyama M Yakabi K Nakamura T Matsuo I Oesophageal involvement in pemphigus vulgaris.Lancet. 1999; 354: 1794Summary Full Text Full Text PDF PubMed Scopus (37) Google Scholar show that oesophageal involvement is common in pemphigus vulgaris. Dermatologists have been aware of this possible involvement in the context of extended buccal erosions and of retrosternal pain after swallowing.2Trattner A Lurie R Leiser A et al.Esophageal involvement in pemphigus vulgaris: a clinical, histologic, and immunopathologic study.J Am Acad Dermatol. 1991; 24: 223-226Summary Full Text PDF PubMed Scopus (51) Google Scholar We usually avoid oesophageal fibroscopy because, first, it is a risky procedure: the extreme fragility of the mucous membranes makes it likely that the fibroscope will aggravate the lesions. In fact, we have observed such an effect on one occasion. Second, there is no specific treatment for oesophageal lesions. This type of patient is usually given high-dose steroids with or without immunosuppressive drugs. I cannot imagine the specific “appropriate treatment of oesophageal lesions” that could be helpful. As far as I am aware, the only appropriate management of such lesions is to avoid trauma. Oesophageal involvement in pemphigus vulgarisAuthors' reply Full-Text PDF