We present a series of cases of acute esophageal necrosis along with a video demonstration. The video captures a case showing the severity of necrosis of the esophageal mucosa; an orogastric tube easily passed through the esophageal lumen and into the right hemithorax. The series also demonstrates the severity of this illness, with an associated high mortality rate.

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We read with interest the manuscript written by Timmer and Bauer entitled ''Determinants of male sexual function in inflammatory bowel disease: a survey-based cross-sectional analysis in 280 men,'' 1 which revealed that sexual desire was markedly affected by depression while erectile and orgasmic function were both significantly affected by inflammatory bowel disease (IBD) activity. In this study, 44% of the patients reported that their sexual lives were severely affected by the disease. Other studies have similarly revealed that women with IBD indicate that sexual function is significantly impacted by their disease.2 Considering the profound morbidities and quality of life issues in patients with IBD, particularly its effect on sexuality, it is imperative that physicians play an integral role in addressing issues related to IBD patients' sexual health.A survey of all women with IBD attending an educational seminar was conducted to determine the frequency at which physicians discuss issues related to IBD and sexuality/sexual functioning with women. All 64 of the women with IBD reported that they received medical care from a primary care provider, gastroenterologist, and obstetrician/gynecologist. Of these, 12 (18.8%) reported that their gastroenterologists more frequently addressed these issues compared to a primary care provider (0%, P ¼ 0.0002) or obstetrician/gynecologist (0%, P ¼ 0.0002). In the patients who had discussions with their gastroenterologists, all of them reported that they (rather than the physician) initiated the discussion.It is critical for physicians to acknowledge that IBD can have an impact on self-image, social relationships, and sexual function.1-3 This study revealed that physicians infrequently addressed issues relating to sexual function. Increasing physicians' sensitivity and awareness of sexual concerns and the potential for sexual dysfunction in IBD patients is essential. Physicians should be encouraged to initiate and address issues related to sexual health and provide disease-specific information as necessary. A multidisciplinary approach to counseling patients on their sexuality and sexual functioning can enhance the likelihood that all issues regarding sexual health are addressed.