S839 Esophageal Lichen Planus: Hard to Swallow, Harder to Diagnose

Introduction: Esophageal lichen planus (ELP) is a rare form of mucocutaneous lichen planus commonly seen in middle-aged women. Patients often present with dysphagia and odynophagia, due to the formation of esophageal lesions and strictures. Relative to other mucosal manifestations of lichen planus, ELP is less frequently reported and has no well-established prevalence. A general lack of knowledge of ELP impedes efficient treatment and diagnosis, resulting in increased time to diagnosis and misdiagnoses of gastroesophageal reflux disease (GERD), eosinophilic esophagitis, and more. To alleviate disease burden, mitigate misdiagnoses, and improve time to diagnosis, characterization and analysis of patients diagnosed with ELP is essential. This study aims to review 15 patients diagnosed with ELP to increase understanding and identify features that impede diagnosis. Methods: This was a retrospective cohort study. Patients aged >18 with a diagnosis of ELP were included. Diagnoses were confirmed through chart review of esophagogastroduodenoscopy (EGD) findings and pathology reports at our institution. Demographic data, treatment details, and histopathologic findings were also collected. Severity was assessed using the ELP Severity Score, developed by Keshav, et al. Results: Fifteen cases of esophageal lichen planus were reviewed. The median number of biopsies before diagnosis of ELP was 3, with a median time to diagnosis of 41 months. All patients were dilated during EGD, with 80% of patients found to have luminal stenosis (median ELP severity: 5). Sixty percent of patients were treated with immunosuppressants (mycophenolate, methotrexate, tacrolimus, azathioprine), 40% were treated with a topical steroid (budesonide, triamcinolone injection), and 13% were treated with an anti-inflammatory (metronidazole). At the time of diagnosis, 47% of our patient cohort had thyroid disease. Following treatment, 67% reported symptomatic improvement with 47% also having luminal diameter improvement. Conclusion: In conclusion, ELP is a debilitating condition that is difficult to diagnose, requiring a median of 3 EGDs with biopsy. In a middle-aged woman with dysphagia and diffuse esophageal narrowing, ELP should always be considered, despite a likely initial failure to make a histologic diagnosis. Therapy should be aimed at decreasing inflammation and dilating to restore esophageal luminal diameter, as this improved symptoms in most of our patient cohort. Future studies are needed to ameliorate histologic analysis.