A relapse case of acute necrotizing esophagitis

Tanaka, Kyosuke; Toyoda, Hideki; Hamada, Yasuhiko; Aoki, M; Kosaka, Ryo; Noda, Takemi; Katsurahara, Masaki; Nakamura, Mitsuji; Ninomiya, Katsuhiro; Inoue, Hirosi; Imoto, Ichiro; Takei, Yuki

doi:10.1055/s-2007-966789

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…Surgery is a common trigger for AEN, perhaps related to a cytokine environment that could compromise mucosal regenerative ability and increase susceptibility to esophageal ischemia secondary to blood loss and hypotensive insults following aggressive surgical procedures, including lower limb amputation [61], total hip arthroplasty [81], cholecystectomy [1,35], rectosigmoid resection [21,72], or pulmonary lobectomy [76]. Occasionally, AEN may also follow less invasive procedures, including ocular surgery for vitreous hemorrhage [82]. Therefore, when symptoms of UGB appear during the postoperative course, especially associated with hypotension, AEN must be considered.…”

Section: Etiologymentioning

confidence: 99%

“…Usually, esophageal mucosa acquires its normal endoscopic appearance in approximately 1-2 weeks, although, depending on the patient’s general condition, this process may take more time [2]. Relapse after complete recovery is not typical, although it has been documented [82]. There is also one case of isolated duodenal necrosis 4 months after an episode of AEN [113].…”

Section: Etiologymentioning

confidence: 99%

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Diagnosis and management of acute esophageal necrosis

Dias

Santos-Antunes

Macedo

2019

aog

113

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Acute esophageal necrosis is a rare syndrome classically characterized by a striking endoscopic image of diffuse and circumferential black mucosal discoloration of distal esophagus, with an abrupt transition at the gastroesophageal junction and variable proximal extension. The typical patient is an older male with general debilitation and multiple comorbidities presenting with hematemesis or melena. The pathophysiology usually involves a combination of esophageal ischemia, backflow injury from gastric chemical contents and impaired mucosal reparative mechanisms associated with debilitated physical states. It may arise in the setting of hemodynamic compromise, diabetic ketoacidosis, hypothermia, alcoholic intoxication, trauma, inflammatory diseases, esophageal local infection, solid organ transplantation, postoperative status, drugs or acute gastric outlet obstruction, usually in the background of a chronic debilitating process, where the concurrent presence of multiple risk factors, including diabetes mellitus, hypertension, malnutrition, malignancy or alcohol abuse, places a patient at higher risk. The characteristic endoscopic appearance establishes the diagnosis. Biopsy is supportive but not required. Management is mainly supportive and consists of correcting coexisting conditions, fluid therapy, bowel rest, intravenous proton pump inhibitor therapy and red blood cell transfusion as needed. Although this is a serious life-threatening condition, appropriate treatment may result in a favorable outcome in the majority of patients.

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Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Diagnosis and management of acute esophageal necrosis

Dias

Santos-Antunes

Macedo

2019

aog

113

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“…Although 1 case report is found in the literature, no study was conducted on risk factors for recurrence in AEN. [27] Of 4 recurrence cases, 3 had co-existing duodenal ulcer in our study. Duodenal bulb ulcer and edema might induce gastric outlet obstruction and potentiated regurgitation of toxic acid into the esophageal mucosa.…”

Section: Discussionmentioning

confidence: 70%

Evaluation of prognostic factor and nature of acute esophageal necrosis

et al. 2019

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Acute esophageal necrosis (AEN) is a serious disease which can causes gastrointestinal bleeding and death. Although black color change is not essential factor of organ necrosis, AEN is also known as “black esophagus.” Because of its rarity, there are limited studies regarding risk factors of mortality and recurrence. Thus, we conducted a multicenter retrospective study in order to evaluate the clinical characteristics of AEN. Method Clinical datum of AEN patients from 7 tertiary hospitals located in Daejeon-Choongcheong province were evaluated based on medical records. Our primary endpoint was risk factors for mortality and the secondary endpoint was risk factors for recurrence and clarifying whether “black esophagus” is a right terminology.Fourty one patients were enrolled. Thirty six patients were male, mean age was 69.5 years. Nine patients had died, and 4 patients showed recurrence. Sepsis and white color change in endoscopy were related to high mortality (Chi-Squared test, P < .05). Old age, high pulse rate, low hemoglobin, and low albumin were also related to high mortality. Unexpectedly, heavy drinking showed favorable a mortality. Septic condition and high pulse rate showed poor mortality in logistic regression test (P < .05). Coexisting duodenal ulcer was related to recurrence (Chi-Squared test, P < .05). There was no difference in the underlying condition except patients with a coexisting cancer and white-form displayed lower hemoglobin level. Conclusion: Our results imply that white color change, septic condition, high pulse rate, and low hemoglobin & albumin are poor prognostic factors in AEN. Further evaluation may help clarify the findings of our study.

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“…This patient was affected by chronic ischaemic heart disease, hypertension and pneumonia and was subsequently diagnosed with ZES. AON reoccurrence is a rare event that has rarely been observed [11,12]. To our knowledge, only two other cases with AON relapse have been reported.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Acute Oesophageal Necrosis (Black Oesophagus) in a Single Tertiary Centre

Orlando¹,

Carabotti²,

Ruggeri³

et al. 2019

JCM

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Acute oesophageal necrosis (AON) is a rare condition characterised by the endoscopic finding of diffuse, circumferential, black mucosal pigmentation of the oesophagus, which typically stops at the gastro-oesophageal junction. This observational study aimed to assess the occurrence, clinical characteristics and outcomes of AON in a consecutive endoscopic cohort in a single tertiary university centre. A retrospective analysis of endoscopic data of upper gastrointestinal endoscopy (UGE) was carried out from 2008 to 2018. Out of 25,970 UGE, 16 patients (0.06%) had AON; 75.0% were men with a median age of 75 years. Almost all patients underwent diagnosis during emergency UGE performed for gastrointestinal bleeding, but one patient was diagnosed during elective UGE for persistent vomiting and diarrhoea. All patients reported one or more pre-existing comorbidities and concomitant acute events. Two patients had AON as the first presentation of Zollinger–Ellison syndrome (ZES). One patient developed an oesophageal stenosis, and another patient presented a relapse of AON. Mortality was 50%, but no patient died as a direct consequence of AON. AON is a rare cause of gastrointestinal bleeding diagnosed mainly during emergency UGE. Our study showed that ZES might manifest with this critical presentation, and endoscopists must be aware of this evidence.

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A relapse case of acute necrotizing esophagitis

Cited by 8 publications

References 5 publications

Diagnosis and management of acute esophageal necrosis

Diagnosis and management of acute esophageal necrosis

Evaluation of prognostic factor and nature of acute esophageal necrosis

Occurrence of Acute Oesophageal Necrosis (Black Oesophagus) in a Single Tertiary Centre

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