OA07.1. Clinical Features and Treatment Outcomes in Esophageal Lichen Planus: A Retrospective Multicenter Cohort Study

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Abstract Topic Benign Disease: Other Background Lichen planus is a chronic immune-mediated skin disease that may involve the esophagus. Esophageal lichen planus (ELP) is considered rare, but likely underdiagnosed. Lack of published guidelines for ELP results in significant treatment variability. Given heterogeneous practice patterns and emerging treatments, further outcome data are needed. Methods A retrospective cohort of ELP patients was assembled from 3 academic centers. Patients ≥ 18 years old were identified by ICD10 code search (L43.8) in the electronic health record, from 2006 to 2025. Patients were included if they had initial endoscopy, histology, and follow-up endoscopy showing features of LP, and excluded if there was diagnostic uncertainty, unavailable procedural documentation, or other esophageal diseases. Endoscopic findings were assessed qualitatively by manual review of reports. Data abstracted included demographics, presenting symptoms, endoscopic/histologic findings, treatment, and clinical outcomes. Statistical analysis was performed in R. Results 193 patients met inclusion criteria. Mean age at index endoscopy was 65 years, 86% were female, 98% were non-Hispanic Caucasian, 39% were ever smokers, and mean BMI was 26. Dysphagia was the most common presenting symptom (90%). Strictures were common (73%), 58% underwent dilation during initial endoscopy. Endoscopic findings included presence of sloughing (20%), exudate (22%) and friability (23%). Histology showed lymphocytic infiltrate (47%), parakeratosis/dyskeratosis (42%) and Civatte bodies (17%). Topical steroids (71%) and PPIs (63%) were used most frequently for treatment. Immunosuppressives (tacrolimus, systemic steroids, mycophenolate, methotrexate, hydroxychloroquine, cyclosporine, azathioprine, JAK inhibitor) were used in 54% of patients. Endoscopic improvement was seen in 66%, with highest response rates in tacrolimus (100%), hydroxychloroquine (100%), and a JAK inhibitor (100%). Symptom improvement was seen in 63%, with the greatest benefit seen in patients treated with a JAK inhibitor (100%) and hydroxychloroquine (86%). Conclusion In this large, multisite cohort, ELP demonstrated significant morbidity, with high rates of dysphagia, strictures, and inflammatory changes. Dilation appeared to be safe, with only a single iatrogenic perforation identified. Esophageal squamous cell cancer risk was low but present, at 4%. Despite heterogeneous treatment practices, several therapies – tacrolimus, hydroxychloroquine, and JAK inhibitors – were associated with marked endoscopic and symptomatic improvement. Prospective studies are needed to clarify the optimal approach to pharmacological management of ELP.

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