Acute Necrotizing Esophagitis: a Large Retrospective Case Series

Augusto, F.; Fernandes, Vítor; Cremers, Marie Isabelle; Oliveira, Ana; Lobato, Cirley Maria de Oliveira; Alves, Antonio; Pinho, Claudio; Freitas, João

doi:10.1055/s-2004-814318

Cited by 124 publications

(136 citation statements)

References 7 publications

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“…AEN predominantly affects older men with comorbidities such as diabetes mellitus and cardiovascular and renal disease. Upper gastrointestinal bleeding manifesting as coffee ground vomitus and hematemesis is one of the commonest presentations and duodenal ulcer and/or duodenitis are frequently found in patients with AEN [2,17,[20][21][22]. In the present study, we found that male sex and the presence of duodenal lesions were more strongly associated with AEML than with sRE.…”

Section: Discussionsupporting

confidence: 52%

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Comparison of Clinical Characteristics of Patients with Acute Esophageal Mucosal Lesion and those with Severe Reflux Esophagitis

et al. 2018

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Background: The term “acute esophageal mucosal lesion (AEML)” includes black esophagitis, and non-black esophagitis characterized by diffuse circumferential erosions without black-appearing mucosa. Black esophagitis is easily diagnosed, whereas non-black esophagitis is often misdiagnosed as severe reflux esophagitis (sRE). The aim of this study was to determine differences in clinical characteristics of patients with AEML and those with sRE. Methods: Thirty-nine patients with sRE and 32 patients with AEML were diagnosed on the basis of endoscopic findings from 2009 to 2016. Characteristics assessed included age, sex, medication use, coexisting endoscopic finding, comorbidities, laboratory tests results, and chief complaints. Results: In contrast with sRE, male sex, need for emergency endoscopy, presence of duodenal lesions, hypertension, and renal dysfunction were positively associated with AEML. Analysis of associations between laboratory data and AEML showed that high white blood cell count, blood urea nitrogen, and blood glucose were significantly associated with an increase OR for AEML. Conclusions: We showed that AEML differed from sRE regarding both endoscopic findings and clinicopathological features. AEML has not been widely recognized, but it should be defined as a distinct inflammatory disease of the esophagus consisting of both black and non-black esophagitis.

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Section: Discussionsupporting

confidence: 52%

“…AEN is reportedly a rare disorder with a prevalence of 0.02-0.28% [17,21,22,24], whereas AEML including black and non-black esophagitis is presumably more common than has hitherto been recognized.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Characteristics of Patients with Acute Esophageal Mucosal Lesion and those with Severe Reflux Esophagitis

et al. 2018

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“…The necrosis and extensive acute inflammation frequently extend into the submucosa and even deeper into the muscularis propria, and may be associated with fibrin thrombi within dilated capillaries in the lamina propria. [4][5][6] Acute esophageal necrosis occurs in elderly patients with multiple underlying medical problems, and is thought to be caused by ischemia, as patients may also have ischemic colitis, recent surgical intervention, or hemodynamic instability. Its pathogenesis also involve gastric outlet obstruction resulting in reflux into the esophagus.…”

Section: Discussionmentioning

confidence: 99%

“…Its pathogenesis also involve gastric outlet obstruction resulting in reflux into the esophagus. [4][5][6] Therefore, acute mucosal necrosis shares several features with sloughing, including older patient age, comorbidities, and location in the mid and lower esophagus, but it is a much deeper and more necrotizing disease than sloughing esophagitis. Acute esophageal necrosis patients and sloughing esophagitis patients are generally older and thus both groups are more likely to have advanced atherosclerotic disease, recent preceding surgical intervention or a period of hemodynamic instability leading to ischemia.…”

Section: Discussionmentioning

confidence: 99%

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Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa

2012

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Sloughing esophagitis is characterized by superficial necrotic squamous epithelium and endoscopic plaques or membranes. According to abstract reports SE affects older, debilitated patients on multiple medications. This study seeks to evaluate the clinical findings in patients with SE. Thirty-one patients with necrotic superficial squamous epithelium, with endoscopic white plaques or membranes, but without fungi, were compared with 34 patients having esophageal biopsies done for any purpose other than Barrett's surveillance. Sloughing esophagits patients were older than controls (56 vs 43.5 years) and were more likely to be taking five or more medications (77 vs 32%), especially central nervous system depressants (65 vs 32%) and medications associated with esophageal injury (55 vs 18%). In 69% the plaques were in the distal and/or mid-esophagus; 23% involved the entire esophagus; 8% were limited to the proximal esophagus. There was no correlation between medication history and site. Sloughing esophagitis patients were likely to be debilitated based on evidence such as being on home oxygen, in nursing homes, bedridden, hospitalized, or malnourished, having metastatic cancer, organ transplantation, and/or being immunosuppressed. Sloughing esophagitis patients were more likely to have died since the biopsy (23 vs 3%), have peptic ulcer disease (55 vs 24%), or renal insufficiency (16% vs none), but no more likely to have dysmotility disorders, irritable bowel disease, or atherosclerosis. SE patients were less likely to have gastroesophageal reflux disease (45 vs 74%). No specific cause for sloughing esophagitis was identified, but the association with multiple drugs and conditions that may lead to esophageal stasis and/or injury, suggest that this is a local, perhaps contact injury, rather than an ischemic injury.

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Miscellaneous Diseases of the Esophagus: Foreign Bodies, Physical Injury, and Systemic and Dermatological Diseases

Crockett¹,

Dellon²,

Shaheen³

2015

Yamada' S Textbook of Gastroenterology

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Acute Necrotizing Esophagitis: a Large Retrospective Case Series

Cited by 124 publications

References 7 publications

Comparison of Clinical Characteristics of Patients with Acute Esophageal Mucosal Lesion and those with Severe Reflux Esophagitis

Comparison of Clinical Characteristics of Patients with Acute Esophageal Mucosal Lesion and those with Severe Reflux Esophagitis

Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa

Miscellaneous Diseases of the Esophagus: Foreign Bodies, Physical Injury, and Systemic and Dermatological Diseases

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