Dysphagia and Odynophagia in a Woman With Hypothyroidism

Xiang Liu, MD; John W. Birk, MD


May 03, 2023

Currently, no treatments have been approved by the US Food and Drug Administration for ELP. Patients are typically treated with endoscopic dilation and topical corticosteroids such as budesonide as first-line therapy. Other step-up therapies that have been used include systemic steroids, retinoids, adrenocorticotropic hormones, cyclosporine, topical tacrolimus, intralesional steroids, rituximab, and adalimumab, all of which have a higher adverse-effect profile.[3]

Patients should be reevaluated in 3 months for symptom improvement and undergo repeated EGD to assess endoscopic changes. Repeated endoscopic dilation should be performed to relieve dysphagia caused by recurrent strictures. Systemic immunosuppressive agents (cyclosporine, azathioprine, and biologics) for other inflammatory disorders, including psoriasis and inflammatory bowel disease, have been used, but use has been based on limited studies in ELP.[5]

It is important to suspect ELP in patients with the appropriate demographics who present with dysphagia and odynophagia, especially those with other mucocutaneous manifestations of lichen planus. Because the findings in ELP can be similar to those in many other esophageal disorders, careful endoscopic assessment coupled with pathohistologic findings typical of ELP can help make an accurate diagnosis. A correct diagnosis is highly important in the successful treatment of the disease. Further studies are needed to assess the efficacy and safety of available treatment options because ELP requires long-term therapy.

The patient in this case was treated with the topical steroid budesonide twice daily for 3 months. At follow-up, she reported significant improvement of dysphagia and odynophagia. No adverse effects were reported. EGD showed improvement of the inflammation but also residual fibrotic strictures that required repeated dilation. The plan for this patient is to continue budesonide, with EGD as needed for dilation.


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