Kukreja Keshav, Kumar Ambuj, Camisa Charles, Jacobs John, Richter Joel E
Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
Research Methodology and Biostatistics Core, Office of Research, University of South Florida Health, Tampa, Florida, USA.
Clin Transl Gastroenterol. 2024 Dec 1;15(12):e00752. doi: 10.14309/ctg.0000000000000752.
Esophageal lichen planus (ELP) is a rare inflammatory disease most seen in middle-aged White women, manifested by sloughing mucosa, thick exudate, and proximal strictures. Most case reports and small series highlight using steroids and other immunosuppressants. To the best of our knowledge, oral tablet tacrolimus has not been studied. We aimed to assess the change in ELP after oral tacrolimus treatment.
The primary outcome was the efficacy of tacrolimus objectively through our scoring system, ELP Severity Score (ELPSS). All consecutive adults with ELP who underwent more than one esophagogastroduodenoscopy by 2 esophagologists and being treated with tacrolimus or other treatment were eligible for inclusion in this retrospective cohort study. Inflammation and fibrostenotic disease were graded using the novel ELPSS.
Twenty-two patients met the inclusion criteria. Half (11) received tacrolimus (dose 1-2 mg twice daily), and half (11) received other therapy (i.e., cyclosporine, topical steroids, or none). Mean ELPSS on the first esophagogastroduodenoscopy, extraesophageal manifestations of disease, presenting symptoms, and baseline characteristics were similar between groups. Among patients on Tac vs No-Tac, there was a statistically significant improvement in ELPSS (mean difference 1.8 pts; 95% confidence interval 0.25-3.38; P = 0.02). Response rate was 89% with Tac vs 30% with No-Tac ( P = 0.025). All 22 patients underwent bougie dilation safely with a mean diameter of 16 mm achieved. Patients on Tac also required less frequent dilation.
Oral tablet tacrolimus reduced the inflammatory and fibrostenotic components of ELP. Thus, low-dose oral tacrolimus is safe and should be considered in patients with more severe disease.
食管扁平苔藓（ELP）是一种罕见的炎症性疾病，多见于中年白人女性，表现为黏膜脱落、浓稠渗出物和近端狭窄。大多数病例报告和小系列研究强调使用类固醇和其他免疫抑制剂。据我们所知，尚未对口服他克莫司片进行研究。我们旨在评估口服他克莫司治疗后ELP的变化。
主要结局是通过我们的评分系统——ELP严重程度评分（ELPSS）客观评估他克莫司的疗效。所有连续的成年ELP患者，由2名食管病学家进行了不止一次食管胃十二指肠镜检查，并接受他克莫司或其他治疗，均符合纳入本回顾性队列研究的条件。使用新的ELPSS对炎症和纤维狭窄性疾病进行分级。
22例患者符合纳入标准。一半（11例）接受他克莫司治疗（剂量为每日两次，每次1 - 2毫克），另一半（11例）接受其他治疗（即环孢素、局部类固醇或未接受治疗）。两组在首次食管胃十二指肠镜检查时的平均ELPSS、疾病的食管外表现、出现的症状和基线特征相似。在接受他克莫司治疗组与未接受他克莫司治疗组之间，ELPSS有统计学显著改善（平均差异1.8分；95%置信区间0.25 - 3.38；P = 0.02）。他克莫司治疗组的缓解率为89%，未接受他克莫司治疗组为30%（P = 0.025）。所有22例患者均安全地接受了探条扩张，平均扩张直径达到16毫米。接受他克莫司治疗的患者扩张频率也较低。
口服他克莫司片可减轻ELP的炎症和纤维狭窄成分。因此，低剂量口服他克莫司是安全的，对于病情较重的患者应予以考虑。
