Lichen Planus Is an Uncommon Cause of Nonspecific Proximal Esophageal Inflammation

Background/Aims: Esophageal lichen planus (LP) has been described as a cause of nonspecific esophagitis that may cause dysphagia, but its incidence is unknown. We aimed to estimate the incidence of esophageal LP in a defined geographic region and describe the clinical characteristics of affected patients. Methods: A histopathology database for a population of 1 million people was searched for all esopha-geal mucosal biopsy results over an 8-year period. Cases showing inflammation or abnormalities without a diagnosis after three or more biopsies were reviewed for findings of LP. Results: Of 13,589 esophageal biopsies, only one received a diagnosis of LP. Seven patients (four male; mean age, 59 years; range, 39 to 76 years) were identified as having chronic dysphagia and nonspecific proximal esophagitis for which no diagnosis could be made. All patients had proximal inflammation, and six of seven had full-thickness lymphocytic infiltration. Elongation of the lamina propria papillae was noted in all patients, whereas six patients had parakeratosis and ballooning. Only one patient had findings potentially con-sistent with, but not sufficient for, a diagnosis of esophageal LP. Conclusions: Esophageal LP appears to be extremely un-common in this North American population, and esophageal biopsy alone is likely not sufficient to establish a diagnosis o