Cyclosporin in the Management of Esophageal Lichen Planus
Bibliographic record
Abstract
Purpose: The first report of cyclosporin in the management of esophageal Lichen Planus. Methods: A 54 yr woman with oral lichen planus was referred for assessment of dysphagia. Esophageal lichen planus was diagnosed. She became steroid dependent. She was then placed on cyclosporin. Results: Lichen planus (LP) is an uncommon disorder of unknown etiology mostly affecting patients in their 5th and 6th decade. It is thought to be an autoimmune process involving the T cells against basal keratinocytes. It mostly affects skin, nails, mucous membranes (especially oral pharynx), vulva and penis. Esophageal involvement is quite rare and can cause strictures, ulcerations and squamous cell cancer. Initially, dysphagia occurred with solid foods and then progressed to soft foods but sparing liquids. She had lost 20 lbs. She did not complain of epigastric pain or reflux symptoms. She has no other significant past medical history. She drinks socially and is a non- smoker. An esophagogastroduodenoscopy (EGD) was performed and she was diagnosed with pill esophagitis. At the same time, she was also diagnosed with lichen planus in her oral pharynx with no involvement of the esophagus. She was treated with a PPI and her GI symptoms resolved. However, the symptoms returned after a year and a repeat EGD revealed white plaques in the esophagus and the biopsy showed dense lichenoid inflammatory infiltrate underneath the lamina propria. She was subsequently treated with dilatations and intermittent glucocorticoids. However, as soon as the steroids were tapered she flared, therefore, she was tried on cyclosporine and she responded well. Diagnosis of LP of the esophagus is crucial for the proper treatment. Symptomatic patients should have EGD and biopsies taken. Some of these patients may require systemic immunosuppression as well as mechanical treatment to prevent weight loss. Surveillance endoscopies should be carried out to monitor for the development of squamous cell carcinoma. Conclusion: Cyclosporine has been used in the past for genital and oral LP, but our case is the first where it has been used successfully for esophageal LP.Figure
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".