Esophagitis dissecans superficialis and autoimmune bullous dermatoses: A review

Esophagitis dissecans superficialis (EDS) is a rare desquamative disorder of the esophagus. It is characterized by sheets of sloughed squamous tissue with normal underlying mucosa. We present a case of a 68-year-old man with severe anemia and a positive fecal occult blood test who was found to have features suggestive of EDS during endoscopy. However, histological features were suggestive of both EDS and fungal esophagitis. To our knowledge, this is the first reported case in literature which discusses the clinical scenario of fungal infection being a possible etiology rather than a commonly accepted differential diagnosis of EDS. We also review the clinical features, diagnostic criteria and treatment of EDS.

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“…Offending agents should be discontinued. Currently, there are no published surveillance guidelines [7, 10]. …”

Section: Discussionmentioning

confidence: 99%

Fungal Esophagitis Presenting With Esophagitis Dissecans Superficialis: Cause or Concurrence? A Diagnostic Conundrum

et al. 2016

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“…2 Esophageal involvement in PV may be more prevalent than previously recognized. 4 Absence of cutaneous or oral pharyngeal lesions and immunofluorescence can assist in ruling out PV.…”

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confidence: 94%

“…1,2 Although no one specific etiology has been identified, a recent study found that patients with EDS were older and were more likely to be chronically debilitated, to have died since biopsy, and to be taking 5 or more medications when compared with the control population. 3 They were more likely to have hypertension and heart conditions such as valvular disease, arrhythmia, and congestive heart failure.…”

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confidence: 97%

Identification of Esophagitis Dissecans Superficialis by Endoscopy

Brownschidle

Ganguly

Wilcox

2014

Clinical Gastroenterology and Hepatology

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“…Few case reports have suggested strong association with desquamating esophageal disorders, in particular Pemphigus Vulgaris [2,3]. Rao at el evaluated 42 patients with vesciculobullous dermatosis and found esophageal involvement in 27 patients (67%) and classical appearance of EDS in 2 patients (5%) [4].…”

Section: Discussionmentioning

confidence: 99%

Esophagitis Dessicans Superficialis - Impressive Endoscopic Appearance of a Benign Condition

Mohiuddin¹

2017

BJSTR

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Cases Case 1 Figure 1:15-year-old male diagnosed with cerebral palsy and seizure disorder was referred for dysphasia to solid food progressing over 3 months to dysphasia to both solids and liquids. His medications included Lamotrigine for his Seizure disorder, Supplemental Iron for Iron deficiency anemia and Lansoprazole once daily for reflux disease. Esophagus gastro duodenoscopy (EGD) showed that the lower third of the esophagus has yellowish plaque like material ( Figure 1a) which on removal revealed sloughed and friable mucosa ( Figure 1b) and a partial stricture at the distal esophagus. A 9 mm scope could not pass the distal esophagus due to a partial stricture but a 5 mm slim scope was passed. Histopathology showed esophageal mucosa with extensive ulceration and granulation tissue. There were no viral inclusions, granuloma, dysplasia or malignancy.Staining for Periodic Acid Schiff (PAS), Herpes Simplex Virus (HSV) and Cytomegalovirus (CMV) was negative. He was prescribed twice daily dose of Proton pump inhibitor therapy (PPI) for 2 months. Upon clinical improvement the patient was prescribed once daily PPI therapy for the next 4 months. Repeat OGD after 6 months of PPI therapy showed a normal and completely healed esophageal mucosa with no evidence of the previously noted partial stricture. (Figure 1c). Case 235-year-old male known to have colon cancer status post total hemicolectomy and on chemotherapy was referred due to persistent dysphasia and recurrent vomiting. Medication history was significant for chemotherapy regimen Folfiri Cetuximab with his last cycle received two weeks back. OGD revealed sloughed lower esophageal mucosa with whitish cast like material adherent to it (Figure 2a). After flushing the casts with water jet the underlying mucosa showed ulcerations and sloughing ( Figure 2b). Histopathology revealed ulceration and inflammation with no granuloma, metaplasia or dysplasia. Stains for CMV and HSV were negative. His chemotherapy was continued and a prescription of twice daily PPI therapy was added. After 4 months the patient had a repeat OGD that showed complete healing and normal esophageal mucosa except for a small hiatus hernia (Figure 2c). The dysphasia and vomiting subsided with mild residual reflux symptoms at 6 months. AbstractEsophagitis Dessicans Superficialis (EDS) refers to a rare and unique lesion of the esophagus characterized by sloughing of esophageal mucosa. A benign condition, it is thought to be a mucosal reaction to various types of insults or a mucosal allergic response. Various clinical presentations, endoscopic appearances and associations with systemic diseases have been described in literature. We report 4 consecutive cases of this rare condition in our endoscopy practice with varying endoscopic characteristics and present a literature review of EDS.

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Esophagitis dissecans superficialis and autoimmune bullous dermatoses: A review

Cited by 57 publications

References 39 publications

Fungal Esophagitis Presenting With Esophagitis Dissecans Superficialis: Cause or Concurrence? A Diagnostic Conundrum

Fungal Esophagitis Presenting With Esophagitis Dissecans Superficialis: Cause or Concurrence? A Diagnostic Conundrum

Identification of Esophagitis Dissecans Superficialis by Endoscopy

Esophagitis Dessicans Superficialis - Impressive Endoscopic Appearance of a Benign Condition

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