Chaklader M, Morris-Larkin C, Gulliver W, McGrath J
Department of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland.
Can J Gastroenterol. 2009 Oct;23(10):686-8. doi: 10.1155/2009/802075.
Lichen planus (LP) is an uncommon disorder of unknown etiology, mostly affecting patients in their fifth and sixth decade of life. It is believed to be an autoimmune process involving T cells directed against basal keratinocytes. It affects the skin, nails, oral pharynx and genitals. Esophageal involvement is quite rare and can cause strictures, ulcerations and squamous cell cancer. The present article describes the case of a 54-year-old woman who was referred for assessment of dysphagia that initially occurred with solids, which then progressed to soft foods but spared liquids. The patient reported a weight loss of 9.1 kg. An esophagogastroduodenoscopy was performed and she was subsequently diagnosed with pill esophagitis. At the same time, she was also diagnosed with oral LP, with no involvement of the esophagus. She was treated with a proton pump inhibitor that resolved her gastrointestinal symptoms. The symptoms returned one year later and a repeat esophagogastroduodenoscopy revealed white plaques due to LP. She was treated with intermittent glucocorticoids. Diagnosis of esophageal LP is crucial for the proper treatment. Some patients may require systemic immunosuppression and mechanical dilation to prevent weight loss. Surveillance endoscopies should be performed to monitor for squamous cell cancer. Cyclosporine has been used for genital and oral LP, but the present case is the first in which it has been used successfully to treat esophageal LP.
扁平苔藓（LP）是一种病因不明的罕见疾病，主要影响五、六十岁的患者。据信这是一个涉及针对基底角质形成细胞的T细胞的自身免疫过程。它会影响皮肤、指甲、口腔咽部和生殖器。食管受累相当罕见，可导致狭窄、溃疡和鳞状细胞癌。本文描述了一名54岁女性的病例，该患者因吞咽困难前来评估，最初吞咽固体食物时出现困难，随后发展到吞咽软食困难，但液体食物不受影响。患者报告体重减轻了9.1千克。进行了食管胃十二指肠镜检查，随后她被诊断为药物性食管炎。与此同时，她还被诊断出患有口腔扁平苔藓，食管未受累。她接受了质子泵抑制剂治疗，胃肠道症状得到缓解。一年后症状复发，再次进行食管胃十二指肠镜检查发现了扁平苔藓引起的白色斑块。她接受了间歇性糖皮质激素治疗。食管扁平苔藓的诊断对于正确治疗至关重要。一些患者可能需要全身免疫抑制和机械扩张以防止体重减轻。应进行监测性内镜检查以监测鳞状细胞癌。环孢素已用于治疗生殖器和口腔扁平苔藓，但本病例是首次成功使用其治疗食管扁平苔藓。
