Acute esophageal necrosis: possible association with terlipressin

Efthymakis, Konstantinos; Massacesi, Chiara; Milano, Angelo; Laterza, Francesco; Tafuri, Emanuele; Cipollone, Francesco; Neri, Matteo

doi:10.1055/s-0034-1365789

Cited by 5 publications

(6 citation statements)

References 5 publications

(7 reference statements)

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“…It may be related to a combination of poor nutritional status, reduced lower esophageal sphincter pressure and increased volume of gastric secretions [78]. Some patients presenting with AEN who have a history of chronic alcoholism also have chronic liver disease, including cirrhosis [22,34,46,47,79,80], a known risk factor for AEN, or earlier hepatic changes, including milder forms of liver disease fibrosis [12,20] or steatosis [55,56]. In addition, AEN may be triggered by acute alcohol abuse [16,20,45,47], perhaps as a result of severe vomiting causing damage to esophageal mucosa [16], or low systemic pressure associated with hypothermia [45] or alcoholic lactic acidosis [47].…”

Section: Etiologymentioning

confidence: 99%

“…Several drugs have also been implicated in the pathogenesis of AEN, including non-steroidal anti-inflammatory drugs (NSAID) [10], antihypertensive agents [36], bismuth subsalicylate [88], terlipressin [79], cocaine [89], cefazolin [60], alendronate [90], haloperidol [91], clozapine [62,92], olanzapine [92], and afatinib [77]. The association between these drugs and black esophagus may be related to several mechanisms.…”

Section: Etiologymentioning

confidence: 99%

“…The association between these drugs and black esophagus may be related to several mechanisms. Esophageal ischemia may be secondary to vasoconstriction induced by vasoconstrictive agents such as terlipressin [79], or cocaine abuse [89], or to a transient low-flow state associated with a combination of antihypertensive drugs [36]. Other drugs, including NSAID [10] or bisphosphonates [90], may induce direct esophageal damage.…”

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%

Section: Etiologymentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and management of acute esophageal necrosis

Dias

Santos-Antunes

Macedo

2019

aog

113

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“…Of these cases, we managed to extract data from 79 articles having 105 cases of AON (online supplementary table 1). 5–82 Data could not be extracted from (n=13) of the articles containing a total of (n=20) cases 4 83–95. The most common reasons for these were unavailability of complete data or the language being other than English.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive review of acute oesophageal necrosis

Ullah¹,

Mehmood

Micaily

et al. 2019

BMJ Case Rep

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Acute oesophageal necrosis, also known as ‘black oesophagus’, is a rare condition characterised by the black discolouration of the oesophageal mucosa on endoscopy and involves the distal oesophagus in majority of cases but may also extend proximally. A number of conditions are found to be associated with it and it is thought to occur due to a combination of hypovolaemia and inadequate oesophageal protective mucosal barrier function. Gastric secretions may have a direct effect on the oesophageal mucosa. We present a case of a woman who presented with haematemesis and significant hypotension after a session of haemodialysis. Black oesophagus was confirmed on esophagogastroduodenoscopy. She was given two units of packed red blood cells and one unit of platelets, and started on a pantoprazole infusion. However, despite rigorous attempts at resuscitation the patient failed to recover.

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“…It can exert vasoconstrictor effects on the systemic circulation; serious ischemic complications are rare and include myocardial infarction, ischemic colitis, and skin necrosis [8–10]. In the English literature to date, terlipressin-induced skin necrosis have been reported in 20 cases, located on the abdominal wall, thigh, leg, calves, fingers, toes, tongue, scalp, scrotum, breast, and esophagus [11–14]. …”

Section: Discussionmentioning

confidence: 99%

Terlipressin-Induced Ischemic Skin Necrosis: A Rare Association

Şenel

2014

Am J Case Rep

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Patient: Male, 65Final Diagnosis: Drug-iduced skin necrosisSymptoms: —Medication: —Clinical Procedure: Skin graftSpecialty: SurgeryObjective:Adverse events of drug therapyBackground:Terlipressin is a synthetic vasopressin analogue that is used in the treatment of bleeding esophageal varices and hepatorenal syndrome in patients with cirrhosis. Serious ischemic adverse events, such as skin necrosis involving the extremities, scrotum, trunk, and abdominal skin, are rarely observed. In the literature to date, 20 cases that developed ischemic skin necrosis due to terlipressin usage have been reported.Case Report:We report a patient with extensive skin necrosis on the infusion site of the right forearm and hand, which developed after the use terlipressin used to treat bleeding oesophageal varices in a 65-year-old man with cirrhosis.Conclusions:Although rare, ischemic complications of terlipressin do occur.

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Acute esophageal necrosis: possible association with terlipressin

Cited by 5 publications

References 5 publications

Diagnosis and management of acute esophageal necrosis

Diagnosis and management of acute esophageal necrosis

Comprehensive review of acute oesophageal necrosis

Terlipressin-Induced Ischemic Skin Necrosis: A Rare Association

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