Track

Clinical Studies

Abstract

Background: Recognition and management of esophageal manifestations in immune-mediated dermatologic conditions, such as lichen planus (LP) and mucous membrane pemphigoid (MMP), is crucial. Typically, esophageal visualization and tissue biopsy via endoscopy are necessary. Multiple authors have now asserted that accurate diagnosis of esophageal disease should include clinical findings, histopathology, and direct immunofluorescence (DIF). Though DIF testing is often requested when LP or MMP are considered, empiric data evaluating DIF testing in this setting are sparse. 
 
Objective: To analyze esophageal DIF testing with regard to diagnostic yield and specimen quality in one academic center. 
 
Methods: A retrospective cohort study of all DIF results from patients seen at our institution who underwent esophageal biopsy and had an available result between January 2017 - October 2023. In all, 99 cases from 94 unique patients were identified.  
 
Results: 44 (44%) specimens contained sufficient tissue for interpretation. Of the sufficient samples, 48% yielded positive or suggestive results while 52% yielded negative or non-diagnostic results. The remaining 56% of cases had minimal to no representation of the basement membrane zone and submucosa and were therefore inadequate for interpretation. 
 
Conclusions and Relevance: Diagnostic yield from technically adequate esophageal DIF specimens was relatively high, with almost half showing diagnostically useful findings. However, over half of the received specimens were too superficial for interpretation, thus limiting the value of testing. Dermatologists may wish to communicate the need to sample intact mucosa and associated submucosa with colleagues performing endoscopic biopsies for DIF evaluation.