ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-CASE Based Discussion Session 6

CASE Based Discussion Session 6 – Ikuo Hirano and panel

Video Transcription

Video Summary

In this video, Dr. Hirano presents a case of a 56-year-old woman with a history of atrial fibrillation and GERD, who complains about dysphagia. She has been managing her GERD effectively with a PPI, but her dysphagia has been progressively worsening over five years. An upper endoscopy at Northwestern revealed characteristic lesions that appeared like ulcers but could be easily peeled off. These lesions were diagnosed as esophageal lichen planus. Dr. Hirano discusses the difficulty in managing this condition since there is no consensus or guidelines on treatment. Swallowed topical corticosteroids have shown some success, but more potent immunosuppression may be needed in severe cases. Other treatment options such as cyclosporine, tacrolimus, rituxan, and TNF inhibitors have also been tried with varying success rates. Dentists often diagnose oral involvement in these patients. Esophageal lichen planus can cause proximal strictures, and repeated endoscopies are required to monitor the condition and rule out malignancy.

Asset Subtitle

The Spectrum of the Lichenoid Esophagus
Refractory EoE

Keywords

Dr. Hirano

esophageal lichen planus

dysphagia

GERD

treatment options