Esophageal Manifestations of Bullous Pemphigoid

Bullous pemphigoid (BP) and mucous membrane pemphigoid (MMP) are autoimmune disorders involving IgG antibodies to basement membrane zone antigens [1]. The natural course of these diseases is that of exacerbations and remissions [2]. Older adults over the age of 60 and men are more likely to be affected [3]. BP manifests as tense, 1-3 cm fluid filled bullae on the skin [2]. The bullae may be on an erythematous base and are usually associated with pruritus [2]. A prodromal phase lasting weeks to months may precede development of bullae [1]. Biopsy of the edge of an intact blister is the gold standard in diagnosis of BP or MMP. Direct immunofluorescence shows linear IgG or linear C3 staining along the basement membrane zone [1]. A diagnosis can also be made through serology. In BP, serology shows IgG antibodies against bullous pemphigoid antigen (BP180 or BP230), which are components of type XVII collagen. In MMP, the antibodies are variable and can include BP180 or BP230 [1].