Esophageal lichen planus: Current knowledge, challenges and future perspectives

Table 3 Diagnostic criteria to establish diagnosis and assess disease severity (modified from Schauer et al[20])

Macroscopic-endoscopic criteria
Specific signs
D	Denudation/sloughing of the mucosa
D1	Iatrogenic denudation (caused by biopsies)
D2	Spontaneous localized denudation < 1 cm2
D3	Spontaneous spacious denudation > 1 cm2
Possible signs
S	Stenosis/stricture
S1	Passable with standard endoscope
S2	Not passable with standard endoscope
H	Hyperkeratosis (whitish, rough mucosa)
T	Trachealization
N	None of the criteria fulfilled
Microscopic criteria- histopathology and direct immunofluorescence
HP	Sloughing of the epithelia (subepithelial, intraepithelial)
	Lymphocytic infiltrate, mainly T-lymphocytes subepithelial, intraepithelial, junctional (region of the basal membrane)
	Intraepithelial apoptosis of keratinocytes (Civatte bodies)
	Dyskeratosis
HP0	Negative
HP1	Weakly positive
HP2	Positive
HP3	Strong positive
F	Fibrinogen deposition along the basal membrane
F0	No visible reaction
F1	Weak positive, discrete depositions visible
F2	Marked fibrinogen depositions along the basal membrane
Severity grading
Severe ELP	≥ D2 and HP ≥ 1 and/or F ≥ 1
Mild ELP	D1 and HP ≥ 1 and/or F ≥ 1; S, H, T, N and HP ≥ 1 and F ≥ 1
No ELP	Criteria not fulfilled in a patient with LP on other localization

HP: Histopathology; F: Immunofluorescence; ELP: Esophageal lichen planus.