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Background: Lichen planus (LP) is a chronic disease of skin and other squamous epithelia of unknown aetiology. It commonly affects the mouth but oesophageal involvement is rare with only 35 cases reported in the world literature.
Case Series: We report 4 cases of oesophageal LP which presented at a single institution. All cases occurred in women, mean age 55 (range 40–63), with oral and vaginal LP. They presented with dysphagia and odynophagia. Diagnosis was made on the basis of history, endoscopic appearance and biopsy. Tight proximal oesophageal strictures were present in all but one.
Treatment: Oesophageal strictures were treated by stepwise dilatation together with systemic and locally injected corticosteroid because of the propensity for koebnerisation in LP. Initial dilatation was to a maximum diameter of 12mm with subsequent dilatations performed up to 15mm depending on symptomatic response. There was dramatic symptom improvement in all patients following dilatation which was maintained up to 15 months. The mean number of dilatations was 4 (range 2–6).
Conclusions: Symptomatic oesophageal LP occurs primarily in middle aged women with vulvo-vaginal gingival syndrome. Strictures respond well to dilatation with concurrent corticosteroid, however repeated dilatations may be required. The role for long-term immunosuppression remains unclear.