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Ahmed A, King W, Middleton CE, Sharma A. Esophagitis Dissecans Superficialis After Thermal Injury. ACG Case Rep J 2024; 11:e01445. [PMID: 39035209 PMCID: PMC11259382 DOI: 10.14309/crj.0000000000001445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Esophagitis dissecans superficialis (EDS) is a rare esophageal condition characterized by sloughing of the esophageal mucosal epithelium, typically associated with a desquamating dermatologic disorder or mucosal irritants. We present a case of a 49-year-old man who presented for thermal burns sustained from an outdoor heater explosion. On body trauma imaging, he was incidentally found to have a midcervical esophageal prominence causing asymptomatic posterior tracheal compression. Endoscopy with esophageal biopsy were performed and consistent with EDS. He never exhibited symptoms associated with this diagnosis. To our knowledge, thermal injury has been a purported, albeit without case reference, etiology of EDS.
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Affiliation(s)
- Abdillahi Ahmed
- Department of Internal Medicine, University of Florida, Gainesville, FL
| | - William King
- Division of Gastroenterology, Hepatology, & Nutrition, University of Florida, Gainesville, FL
| | - Charles E. Middleton
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Anil Sharma
- Division of Gastroenterology, Hepatology, & Nutrition, University of Florida, Gainesville, FL
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2
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Iwamuro M, Kawano S, Otsuka M. Drug-induced mucosal alterations observed during esophagogastroduodenoscopy. World J Gastroenterol 2024; 30:2220-2232. [PMID: 38690017 PMCID: PMC11056913 DOI: 10.3748/wjg.v30.i16.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/24/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
Several features of drug-induced mucosal alterations have been observed in the upper gastrointestinal tract, i.e., the esophagus, stomach, and duodenum. These include pill-induced esophagitis, desquamative esophagitis, worsening of gastroesophageal reflux, chemotherapy-induced esophagitis, proton pump inhibitor-induced gastric mucosal changes, medication-induced gastric erosions and ulcers, pseudomelanosis of the stomach, olmesartan-related gastric mucosal inflammation, lanthanum deposition in the stomach, zinc acetate hydrate tablet-induced gastric ulcer, immune-related adverse event gastritis, olmesartan-asso-ciated sprue-like enteropathy, pseudomelanosis of the duodenum, and lanthanum deposition in the duodenum. For endoscopists, acquiring accurate knowledge regarding these diverse drug-induced mucosal alterations is crucial not only for the correct diagnosis of these lesions but also for differential diag-nosis of other conditions. This minireview aims to provide essential information on drug-induced mucosal alterations observed on esophagogastroduodenoscopy, along with representative endoscopic images.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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3
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Qasim A, Jyala A, Ghazanfar H, Baqui A, Patel H. Esophagitis Dissecans Superficialis: Unveiling the Enigmatic Entity of Esophageal Mucosal Sloughing. Cureus 2023; 15:e43549. [PMID: 37719494 PMCID: PMC10502395 DOI: 10.7759/cureus.43549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Esophagitis dissecans superficialis (EDS), formerly referred to as sloughing esophagitis, is a degenerative condition affecting the squamous epithelium. EDS is known to be a benign condition that resolves on its own. The exact etiology of EDS remains unclear, although associations with medications like bisphosphonates or nonsteroidal anti-inflammatory drugs, skin conditions, heavy smoking, and physical trauma have been reported. The clinical manifestations exhibit a wide range, encompassing both incidental findings and symptomatic presentations related to the esophagus. Here we present an interesting case of a middle-aged female patient with dysphagia who underwent early esophagogastroduodenoscopy (EGD) for timely identification and treatment of EDS, emphasizing the significance of early detection and management.
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Affiliation(s)
- Abeer Qasim
- Internal Medicine, BronxCare Health System, New York, USA
| | | | | | - Aam Baqui
- Pathology, BronxCare Health System, New York, USA
| | - Harish Patel
- Internal Medicine, BronxCare Health System, New York, USA
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4
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Senyondo G, Khan A, Malik F, Oranu A. Esophagitis Dissecans Superficialis: A Frequently Missed and Rarely Reported Diagnosis. Cureus 2022; 14:e21647. [PMID: 35233324 PMCID: PMC8881116 DOI: 10.7759/cureus.21647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/29/2022] Open
Abstract
Esophagitis dissecans superficialis (EDS) is a rare esophageal disease with a wide spectrum of presentations from asymptomatic to debilitating symptoms. There is a strong association of EDS with autoimmune diseases, smoking, and medications, but it can also be idiopathic. Due to the sporadic occurrence of EDS, identification requires a high index of suspicion to avoid frequent misdiagnoses. Herein, we present a case of EDS associated with the long-standing use of oral diclofenac with a favorable outcome after therapy with a proton pump inhibitor (PPI).
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Kanagalingam G, Sostre Santiago V, Vyas V, Manocha D. Gastrointestinal Hemorrhage From Esophageal Dissecans Superficialis After the Initiation of a Tyrosine Kinase Inhibitor. Cureus 2021; 13:e16471. [PMID: 34422498 PMCID: PMC8371414 DOI: 10.7759/cureus.16471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
Esophagitis dissecans superficialis (EDS) is described as the peeling of squamous mucosa of the esophagus with regurgitation of esophageal casts. It is a rare endoscopic finding associated with chemical irritants, autoimmune disorders, or medications. Most patients are asymptomatic but clinical manifestations can include dysphagia, heartburn, bleeding, or vomiting. In this report, we present a case of a 70-year-old man with a previous history of small cell lung and hepatocellular carcinoma for which he had undergone chemoradiation and immunotherapy. He had presented with upper gastrointestinal hemorrhage manifested as coffee ground emesis. Endoscopic findings were consistent with EDS. No recurrence of his gastrointestinal hemorrhage was observed after acid-suppressive therapy. With our case report, we aim to increase awareness for EDS as a differential diagnosis for gastrointestinal hemorrhage.
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Affiliation(s)
- Gowthami Kanagalingam
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | | | - Vrinda Vyas
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Divey Manocha
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
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6
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Ettel MG, Gonzalez RS. Microscopic Esophageal Sloughing Is Not Specific to "Sloughing Esophagitis". Am J Clin Pathol 2021; 155:895-902. [PMID: 33283861 DOI: 10.1093/ajcp/aqaa195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES "Sloughing esophagitis" (SE) is characterized by a 2-toned squamous epithelium with superficial necrotic keratinocytes overlying viable epithelium. We compared histologic and clinical findings to determine how cases clinically diagnosed as SE differed from cases with histologic sloughing but a different clinical diagnosis. In addition, we compared cases with inflammatory and noninflammatory histology. METHODS We searched departmental archives for esophageal biopsies with histologic sloughing features. We compared clinical and histologic findings for cases with and without clinical confirmation of SE and with and without histologic inflammation. RESULTS We identified 52 patients, of whom 10 (19%) had clinically diagnosed SE, 18 (35%) had another diagnosis, and 24 (46%) had an unclear diagnosis. Endoscopic sloughing tended to be reported more often in cases with SE (P = .07). Histologic features did not discriminate between SE and other etiologies. Esophagitis resolved in 18 of 31 patients with follow-up, with no difference between sloughing and nonsloughing cases (P = .26). There were no clinical differences based on inflammatory and noninflammatory histology. CONCLUSIONS SE has a classic microscopic appearance, but its findings are not specific, although endoscopic sloughing helps correlate histologic and clinical findings. In cases with histologic sloughing, pathologists should raise a broad differential diagnosis.
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Affiliation(s)
- Mark G Ettel
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
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Tao X, Yu G, Guo W, Kan B, Song L, Li H, Jian X. Esophagitis dissecans superficialis associated with acute transoral paraquat poisoning: Clinical study of 15 cases. Sci Prog 2021; 104:368504211019647. [PMID: 34019441 PMCID: PMC10454878 DOI: 10.1177/00368504211019647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To analyze the clinical characteristics and therapeutic effects of transoral paraquat poisoning combined with Esophagitis dissecans superficialis (EDS). A retrospective observational study was conducted on paraquat poisoning patients between January 1, 2011 and August 30, 2016 in Qilu hospital. Fifteen patients with EDS were enrolled in this study. The clinical characteristics, prognosis, and pathological features of esophageal necrosis mucosa of these patients were retrospectively analyzed and summarized. Esophageal mucosal dissection occurs mainly within 3-8 days after transoral paraquat poisoning in 15 patients. Dosage of paraquat is range from 50 to 100 ml. Most patients have physical problems with swallowing before the intramural esophageal dissection occurred. And there are other symptoms, including sore throat or dysphagia (100%), nausea and vomiting (86.7%), heartburn or upper abdominal pain (73.3%), hematemesis (60%), abdominal distension (20%) and cough frequently (6.7%). In death group, most patients demonstrate features of the multiple organ failure when the esophageal mucosal stripping happened, including lung injury, renal failure, and hepatic failure. The shape of esophageal dissection was tubular in 60%, irregular in 40%, and they vary in size. Pathological examination showed extensive injury, necrosis and hemorrhage of digestive tract epithelium, and obvious inflammatory reaction of epithelial tissue. Transoral paraquat poisoning has certain damage to the patient's esophageal mucosa, and some may be complicated with EDS, and the prognosis is poor, especially when combined with multiple organ dysfunction. Esophageal damage is mainly located in the esophageal mucosa and have different degrees. Special attention should be paid on such patients.
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Affiliation(s)
- Xiaogen Tao
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
- Department of Intensive Care Medicine (ICU), The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Guangcai Yu
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Wei Guo
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
- Department of Intensive Care Medicine (ICU), The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Baotian Kan
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Lingli Song
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Hai Li
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Disease, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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Then EO, Grantham T, Lopez M, Reddy M, Gaduputi V. Esophagitis Dissecans Superficialis (EDS) Secondary to Hair Dye Ingestion: Case Report and Literature Review. Clin Pract 2021; 11:185-189. [PMID: 33805260 PMCID: PMC8103253 DOI: 10.3390/clinpract11020026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 11/21/2022] Open
Abstract
Esophagitis dissecans superficialis (EDS) is a rare and underdiagnosed esophageal lesion characterized by sloughing of the esophageal mucosa that has been associated with medications, various autoimmune disorders, and exposure to some chemical irritants. Anatomically, EDS is most commonly seen in the middle and distal thirds of the esophagus. When present, EDS is best treated by discontinuing the offending agent and initiating pharmacologic therapy with proton pump inhibitors. Steroids may also be effective if the etiology is autoimmune in nature. Our case highlights a 65-year-old female diagnosed with EDS after incidental ingestion of hair dye containing resorcinol and para-phenylenediamine (PPD).
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Affiliation(s)
- Eric Omar Then
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY 11201, USA;
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY 10457, USA; (M.L.); (V.G.)
- Correspondence: ; Tel.: +1-(917)-544-9015
| | - Tyler Grantham
- Department of Internal Medicine, St. George’s University School of Medicine, West Indies, Grenada;
| | - Michell Lopez
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY 10457, USA; (M.L.); (V.G.)
| | - Madhavi Reddy
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY 11201, USA;
| | - Vinaya Gaduputi
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY 10457, USA; (M.L.); (V.G.)
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9
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Malone V, Sheahan K. Novel and rare forms of oesophagitis. Histopathology 2020; 78:4-17. [PMID: 33382498 DOI: 10.1111/his.14284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022]
Abstract
Our understanding of inflammatory diseases of the gastrointestinal tract, including those of the oesophagus, has expanded in recent years. Once attributed almost exclusively to gastro-oesophageal reflux disease or infection, it is now recognised that oesophagitis may occur due to a variety of distinct disease entities. Many of these conditions cause debilitating and persistent symptoms, impacting upon quality of life and necessitating ongoing surveillance and treatment. This review will consider the clinical, endoscopic and histopathological features of these novel and rare forms of oesophagitis.
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Affiliation(s)
- Victoria Malone
- Department of Histopathology, St Vincent's University Hospital, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Kieran Sheahan
- Department of Histopathology, St Vincent's University Hospital, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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10
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Iwamuro M, Ennishi D, Matsuoka KI, Tanaka T, Okanoue S, Obayashi Y, Sakae H, Kawahara Y, Okada H. Four Cases of Desquamative Esophagitis Occurring after Hematopoietic Stem Cell Transplantation. Intern Med 2020; 59:3015-3022. [PMID: 32759586 PMCID: PMC7759710 DOI: 10.2169/internalmedicine.4977-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report four patients with desquamative esophagitis that developed one to nine days after peripheral blood stem cell transplantation (PBSCT). Three patients underwent allogeneic PBSCT for leukemia, and the other underwent autologous PBSCT for pineoblastoma. Esophagogastroduodenoscopy revealed mucosal sloughing and fresh blood in the esophagus. Fasting and intravenous proton pump inhibitor therapy in addition to blood transfusion improved the esophageal lesions within five to seven days in three patients. These cases indicate that desquamative esophagitis can occur in patients who receive hematopoietic stem cell transplantation. Although blood transfusions may be required, it can be resolved within seven days.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | | | - Shotaro Okanoue
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Yuka Obayashi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hiroyuki Sakae
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Hospital, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Mastracci L, Grillo F, Parente P, Unti E, Battista S, Spaggiari P, Campora M, Valle L, Fassan M, Fiocca R. Non gastro-esophageal reflux disease related esophagitis: an overview with a histologic diagnostic approach. Pathologica 2020; 112:128-137. [PMID: 33179617 PMCID: PMC7931579 DOI: 10.32074/1591-951x-156] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
Several pathological conditions, other than gastro-esophageal reflux disease and its complications, can affect the esophagus. While some of these can present with unspecific lesions (i.e. ulcers and epithelial damage) and require clinico-pathological correlation for diagnosis (i.e. drug-induced esophagitis and corrosive esophagitis) other conditions show distinctive histological lesions which enable the pathologist to reach the diagnosis (i.e. some specific infectious esophagites and Crohn's disease). In this context eosinophilic esophagitis is the condition which has been increasingly studied in the last two decades, while lymphocytic esophagitis, a relatively new entity, still represents an enigma. This overview will focus on and describe histologic lesions which allow pathologists to differentiate between these conditions.
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Affiliation(s)
- Luca Mastracci
- Correspondence Luca Mastracci Anatomic Pathology Section, University of Genova and Ospedale Policlinico San Martino, largo Rosanna Benzi 10, 16132 Genova, Italy Tel. +39 010 5555954 Fax: +39 010 5556932 E-mail:
| | | | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Elettra Unti
- UOC Anatomia Patologica, ARNAS Ospedali Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Serena Battista
- SOC di Anatomia Patologica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Paola Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Michela Campora
- Anatomic Pathology, San Martino IRCCS Hospital, Genova, Italy
| | - Luca Valle
- Anatomic Pathology, San Martino IRCCS Hospital, Genova, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Italy
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Sarraj R, Bionda M, Dawson H, Krupka N. Recurrent dysphagia after bariatric surgery. Frontline Gastroenterol 2020; 12:700-701. [PMID: 34917331 PMCID: PMC8640427 DOI: 10.1136/flgastro-2020-101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Riad Sarraj
- Department of Visceral Surgery and Medicine, Gastroenterology, Inselspital University Hospital, Bern, Switzerland
| | - Marion Bionda
- Department of Visceral Surgery and Medicine, Gastroenterology, Inselspital University Hospital, Bern, Switzerland
| | - Heather Dawson
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Niklas Krupka
- Department of Visceral Surgery and Medicine, Gastroenterology, Inselspital University Hospital, Bern, Switzerland
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13
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Jaben I, Schatz R, Willner I. The Clinical Course and Management of Severe Esophagitis Dissecans Superficialis: A Case Report. J Investig Med High Impact Case Rep 2020; 7:2324709619892726. [PMID: 31818144 PMCID: PMC6904778 DOI: 10.1177/2324709619892726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Esophagitis dissecans superficialis is a rare clinical endoscopic finding with poorly understood pathogenesis and ill-defined management. A 71-year-old man is admitted with progressively worsening dysphagia and odynophagia with endoscopic features most consistent with severe esophagitis dissecans superficialis. Extensive workup did not reveal an etiology, and he was subsequently treated with steroids, resulting in rapid, almost complete clinical and endoscopic recovery.
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Affiliation(s)
- Isaac Jaben
- Medical University of South Carolina, Charleston, SC, USA
| | - Richard Schatz
- Medical University of South Carolina, Charleston, SC, USA
| | - Ira Willner
- Medical University of South Carolina, Charleston, SC, USA
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14
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Binder L, Högenauer C, Langner C. Gastrointestinal effects of an attempt to avoid contracting COVID-19 by 'disinfection'. Histopathology 2020; 77:327-328. [PMID: 32379368 PMCID: PMC7267257 DOI: 10.1111/his.14137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lukas Binder
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, and Diagnostic & Research Centre for Molecular BioMedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Christoph Högenauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, and Diagnostic & Research Centre for Molecular BioMedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Cord Langner
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, and Diagnostic & Research Centre for Molecular BioMedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
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15
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First Case of Esophagitis Dissecans Superficialis in an HIV Patient: A Case Report and Literature Review. Case Rep Infect Dis 2019; 2019:4616937. [PMID: 31355025 PMCID: PMC6636498 DOI: 10.1155/2019/4616937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/27/2019] [Accepted: 06/13/2019] [Indexed: 12/04/2022] Open
Abstract
Esophagitis dissecans superficialis (EDS), a rare desquamative esophageal disease of uncertain etiology, is characterized by sloughing of fragments of esophageal mucosa. To the best of our knowledge, there has been no reported case of EDS in an HIV-infected patient. We report the first case of EDS in an adult HIV-infected male, who was hospitalized due to dysphagia. Esophagogastroscopy was performed, and the endoscopic findings together with the histopathologic findings of esophageal tissues were consistent with EDS. However, his symptom of dysphagia was not explained by EDS, but was the early symptoms of muscle-specific kinase (MuSK) myasthenia gravis (MG) that we finally diagnosed later by progression of the symptoms and electrophysiologic study. His symptoms had gradually improved after a course of intravenous immunoglobulin treatment. This is the first case of EDS and MuSK myasthenia gravis in an HIV-infected patient. A high index of suspicion of EDS should be made when taking care of the patients with desquamative or sloughing esophagitis especially with unknown etiology.
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16
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Esophagitis in patients without gastroesophageal reflux disease or eosinophilic esophagitis: diagnostic considerations. Curr Opin Gastroenterol 2019; 35:379-386. [PMID: 33216485 DOI: 10.1097/mog.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW A multitude of inflammatory diseases other than gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can affect the esophagus. Despite the deceptively simple organization of squamous mucosa and its limited number of inflammatory responses, a wide array of histologic patterns can be seen in inflammatory disorders involving the esophagus. Each such histologic pattern is associated with a limited number of underlying conditions, and the clinician can use this information to narrow the differential diagnosis. The purpose of this review is to review and discuss the pathologic diagnosis of esophagitis caused by conditions other than GERD or eosinophilic esophagitis, with an emphasis on recent developments in the field. RECENT FINDINGS Recent studies suggest that lymphocytic esophagitis may be a histologic manifestation of esophageal motility disorders. Immunophenotypic features of infiltrating lymphocytes may be helpful in this scenario. immunoglobulin G4-related disease has been implicated as a cause of esophageal inflammation with ulceration, strictures, and mass-forming fibrosis, whereas epidermoid metaplasia has been linked molecularly to the squamous cell neoplasia pathway. SUMMARY Improved knowledge and appreciation of the pathology of esophageal inflammation are needed to better understand the pathogenesis of various types of esophagitis, and to inform new approaches to the therapy and management of inflammatory esophageal diseases.
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Sun L, Hickey CA, Harris BR, Maluf HM, He M. Pediatric Sloughing Esophagitis: A Case Report and Discussion. Fetal Pediatr Pathol 2018; 37:210-215. [PMID: 29781748 DOI: 10.1080/15513815.2018.1469702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Sloughing esophagitis is an uncommon entity with an unclear pathogenesis characterized by desquamating sheets of squamous mucosa. It has been associated with bullous dermatologic disorders, other autoimmune diseases and has been most commonly reported in elderly, debilitated individuals on multiple medications. CASE REPORT We report sloughing esophagitis in a previously healthy 17 year-old girl. While the initial trigger of her esophagitis is unclear, she improved with proton pump inhibitor therapy and swallowed fluticasone, with complete resolution after 6 months. CONCLUSIONS Sloughing esophagitis can occur in the pediatric population. We discuss the presentation, differential diagnosis, and treatment of sloughing esophagitis in adolescents.
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Affiliation(s)
- Lulu Sun
- a Department of Pathology and Immunology , Washington University in Saint Louis School of Medicine, Saint Louis , Missouri , USA
| | - Christina A Hickey
- a Department of Pathology and Immunology , Washington University in Saint Louis School of Medicine, Saint Louis , Missouri , USA
| | - Brendan R Harris
- a Department of Pathology and Immunology , Washington University in Saint Louis School of Medicine, Saint Louis , Missouri , USA
| | - Horacio M Maluf
- a Department of Pathology and Immunology , Washington University in Saint Louis School of Medicine, Saint Louis , Missouri , USA
| | - Mai He
- a Department of Pathology and Immunology , Washington University in Saint Louis School of Medicine, Saint Louis , Missouri , USA
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Gopal P, Gibson JA, Lisovsky M, Nalbantoglu ILK. Unique causes of esophageal inflammation: a histopathologic perspective. Ann N Y Acad Sci 2018; 1434:219-226. [PMID: 29766506 DOI: 10.1111/nyas.13732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
Gastroenterologists frequently perform endoscopic esophageal mucosal biopsies for pathologic diagnosis in patients experiencing symptoms of esophagitis. The more common causes of esophagitis diagnosed on esophageal mucosal biopsy include reflux esophagitis, eosinophilic esophagitis, and infectious esophagitis caused by Candida albicans, herpes simplex virus, and/or cytomegalovirus. However, there are several causes of esophagitis seen less frequently by pathologists that are very important to recognize. We discuss unique types of esophageal inflammation, including acute bacterial esophagitis, esophageal manifestations of dermatologic diseases, medication-induced esophageal injury, and sloughing esophagitis; and we review their clinical and histopathologic features.
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Affiliation(s)
- Purva Gopal
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joanna A Gibson
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Mikhail Lisovsky
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - ILKe Nalbantoglu
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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19
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Zhang X, Patil D, Odze RD, Zhao L, Lisovsky M, Guindi M, Riddell R, Bellizzi A, Yantiss RK, Nalbantoglu I, Appelman HD. The microscopic anatomy of the esophagus including the individual layers, specialized tissues, and unique components and their responses to injury. Ann N Y Acad Sci 2018; 1434:304-318. [PMID: 29761508 DOI: 10.1111/nyas.13705] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/27/2018] [Accepted: 03/11/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Xuchen Zhang
- Department of PathologyYale University New Haven Connecticut
| | - Deepa Patil
- Department of PathologyCleveland Clinic Cleveland Ohio
| | - Robert D. Odze
- Department of Pathology, Brigham and Women's Hospital Boston Massachusetts
- Department of PathologyHarvard University Boston Massachusetts
| | - Lei Zhao
- Department of Pathology, Brigham and Women's Hospital Boston Massachusetts
- Department of PathologyHarvard University Boston Massachusetts
| | - Mikhail Lisovsky
- Department of PathologyDartmouth University Lebanon New Hampshire
| | - Maha Guindi
- Department of Pathology and Laboratory MedicineCedars‐Sinai Hospital Los Angeles California
| | - Robert Riddell
- Department of Pathology and Laboratory MedicineMount Sinai Hospital Toronto Ontario
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto Toronto Ontario
| | | | - Rhonda K. Yantiss
- Department of Pathology and Laboratory MedicineWeill Cornell Medicine New York New York
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Panarelli NC. Other Forms of Esophagitis: It Is Not Gastroesophageal Reflux Disease, So Now What Do I Do? Surg Pathol Clin 2017; 10:765-779. [PMID: 29103532 DOI: 10.1016/j.path.2017.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Esophagitis results from diverse causes, including gastroesophageal reflux, immune-mediated or allergic reactions, therapeutic complications, and infections. The appropriate clinical management differs in each of these situations and is often guided by pathologic interpretation of endoscopic mucosal biopsy specimens. This review summarizes the diagnostic features of unusual forms of esophagitis, including eosinophilic esophagitis, lymphocytic esophagitis, esophagitis dissecans superficialis, drug-induced esophageal injury, and bullous disorders. Differential diagnoses and distinguishing features are emphasized.
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Affiliation(s)
- Nicole C Panarelli
- Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10467, USA.
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21
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Johncilla ME, Srivastava A. Esophagitis unrelated to reflux disease: current status and emerging diagnostic challenges. Virchows Arch 2017; 472:29-41. [DOI: 10.1007/s00428-017-2238-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 02/07/2023]
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22
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Patil R, Sunkara T, Ona MA, Gaduputi V, Reddy M. Fungal Esophagitis Presenting With Esophagitis Dissecans Superficialis: Cause or Concurrence? A Diagnostic Conundrum. Gastroenterology Res 2016; 9:108-110. [PMID: 28058081 PMCID: PMC5191900 DOI: 10.14740/gr739w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 01/08/2023] Open
Abstract
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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Affiliation(s)
- Rashmee Patil
- Department of Internal Medicine, Mount Sinai Health Systems, E 101st, New York, NY 10029, USA
| | - Tagore Sunkara
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, 121 Dekalb Ave., Brooklyn, NY 11201, USA
| | - Mel A Ona
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, 121 Dekalb Ave., Brooklyn, NY 11201, USA
| | - Vinaya Gaduputi
- Department of Gastroenterology and Hepatology, SBH Health System,4422 Third Ave, Bronx, NY 10457, USA
| | - Madhavi Reddy
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, 121 Dekalb Ave., Brooklyn, NY 11201, USA
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23
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Sloughing Esophagitis: An Atypical Cause of Food Impaction. ACG Case Rep J 2016; 3:e85. [PMID: 27807547 PMCID: PMC5062645 DOI: 10.14309/crj.2016.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/10/2016] [Indexed: 12/02/2022] Open
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24
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Moawad FJ, Appleman HD. Sloughing esophagitis: a spectacular histologic and endoscopic disease without a uniform clinical correlation. Ann N Y Acad Sci 2016; 1380:178-182. [PMID: 27384256 DOI: 10.1111/nyas.13112] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
Abstract
Sloughing esophagitis, also currently known as esophagitis dissecans superficialis, is a degenerative disease of the squamous epithelium characterized by superficial epithelial necrosis with parakeratosis, but without inflammation, and detachment of the superficial necrotic zone from the deep viable zone. This leads to a spectacular endoscopic appearance of sloughed mucosa in streaks and patches. The cause is unknown, and the clinical characteristics are variable, ranging from incidentally findings to esophageal symptoms. The disease seems to be self-limited, as resolution of the changes was observed in the few cases for which follow-up endoscopic examinations have been reported.
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Affiliation(s)
- Fouad J Moawad
- Gastroenterology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - Henry D Appleman
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
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25
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Mostafa I. Emerging stars: developing a program for future leaders. Dig Endosc 2016. [DOI: 10.1111/den.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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26
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Esophagitis Dissecans Superficialis: Clinical, Endoscopic, and Histologic Features. Dig Dis Sci 2015; 60:2049-57. [PMID: 25701324 DOI: 10.1007/s10620-015-3590-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the esophagus, but there is a paucity of the literature regarding this condition. AIM We examined our institution's experience to further characterize clinical outcomes, and endoscopic and histopathologic features. METHODS Endoscopy and pathology databases were retrospectively reviewed from 2000 to 2013 at Mayo Clinic Rochester to identify potential cases of EDS. Medical records and endoscopic images were reviewed to identify cases, and original pathologic specimens were also reviewed. Clinical, endoscopic, and histologic characteristics of EDS were defined. RESULTS Forty-one subjects were identified with a median age at diagnosis of 65.0 years (IQR 52.8-76.1) and a female preponderance (63.4 %). Many patients were taking a psychoactive agent (73.1 %) or acid-suppressive therapy (58.5 %) preceding the index endoscopy. Strips of sloughed membranes had a predilection for the distal and/or middle esophagus and resolved in 85.7 % of subjects at endoscopic follow-up. Parakeratosis and intraepithelial splitting were histologic features seen in all patients, while splitting of the connective tissue and intraepithelial bullae were seen in 46.2 and 11.1 %, respectively. There were no disease-related complications at a median follow-up of 10.4 months (IQR 1.2-17.2). CONCLUSIONS EDS is likely under-recognized. A distinct endoscopic feature of EDS is "sloughing" strips of mucosa with parakeratosis and intraepithelial splitting being sine qua non histologic findings. The use of psychoactive agents (particularly a SSRI or SNRI) was prevalent at endoscopic diagnosis, although the clinical relevance of this is uncertain. EDS appears to be a benign, incidental finding without complications.
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27
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Affiliation(s)
- K K Rawal
- Department of Gastroenterology and Liver Disease, Milestone Hospital, Vidyanagar, Main Road, Rajkot, 360 002, India.
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28
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Abstract
Context
Inflammatory lesions of the esophagus are a diverse group, often with nonspecific histologic findings. These benign changes can produce diagnostic difficulties for pathologists.
Objective
To discuss the typical histologic findings of a variety of the most common causes of esophagitis (reflux, eosinophilic esophagitis, infections, medications) along with less common issues such as sloughing esophagitis and skin disorders involving the squamous mucosa.
Data Sources
The literature has been reviewed to discuss histologic definitions of current and developing issues in the area of esophagitis.
Conclusions
Histologic features are not entirely sensitive and specific for inflammatory esophageal disorders. Awareness of these problems is essential; clinical and endoscopic information can be very useful in distinguishing among the various lesions.
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Affiliation(s)
- Andrea Grin
- From the Department of Laboratory Medicine (Pathology) and the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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29
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Esophageal dissecans: a rare life-threatening presentation of recurrent pemphigus vulgaris. Am J Emerg Med 2015; 33:1845.e1-2. [PMID: 25983121 DOI: 10.1016/j.ajem.2015.04.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 04/09/2015] [Indexed: 11/17/2022] Open
Abstract
Esophagitis dissecans superficialis (EDS) is a rare condition characterized by sloughing of the mucosal layer of the esophageal lining, usually triggered by an environmental/immune insult. It is associated with blistering diseases such as pemphigus vulgaris (PV), bullous pemphigoid, and epidermolysis bullosa. Oral mucosa is the most commonly (50%) affected site in PV, but esophageal involvement has only been rarely reported. The most common presentation of EDS includes dysphagia and odynophagia, but overt gastrointestinal bleeding is a distinctly uncommon. We present a unique case of EDS presenting with melena in which diagnostic endoscopy enabled to diagnose and establish link with patient's remote history of PV. Early suspicion and identification of this treatable condition can reduce morbidity and mortality in these patient populations by decreasing severity and recurrence of bleeding.
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30
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Costa Santos V, Ávila F, Massinha P, Nunes N, Rego AC, Pereira JR, Paz N, Duarte MA. Sloughing Esophagitis: A Rare Cause of Dysphagia. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:37-38. [PMID: 28868369 PMCID: PMC5580110 DOI: 10.1016/j.jpge.2014.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/02/2014] [Indexed: 11/24/2022]
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31
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Ma C, Limketkai BN, Montgomery EA. Recently highlighted non-neoplastic pathologic entities of the upper GI tract and their clinical significance. Gastrointest Endosc 2014; 80:960-9. [PMID: 25434655 DOI: 10.1016/j.gie.2014.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/03/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Changqing Ma
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Berkeley N Limketkai
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth A Montgomery
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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32
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Brownschidle SS, Ganguly EK, Wilcox RL. Identification of esophagitis dissecans superficialis by endoscopy. Clin Gastroenterol Hepatol 2014; 12:e79-80. [PMID: 24607699 DOI: 10.1016/j.cgh.2014.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/20/2014] [Accepted: 02/24/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Sara S Brownschidle
- Department of Pathology and Laboratory Medicine, University of Vermont/Fletcher Allen Health Care, Burlington, Vermont
| | - Eric K Ganguly
- Department of Gastroenterology, University of Vermont/Fletcher Allen Health Care, Burlington, Vermont
| | - Rebecca L Wilcox
- Department of Pathology and Laboratory Medicine, University of Vermont/Fletcher Allen Health Care, Burlington, Vermont
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33
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Golovyan D, Mehdi A, Alraies MC. A young woman with pancreatitis and odynophagia. QJM 2014; 107:685-6. [PMID: 24448379 DOI: 10.1093/qjmed/hcu006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Golovyan
- Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - A Mehdi
- Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - M C Alraies
- Hospital Medicine, Cleveland Clinic Foundation, 950 Euclid Avenue, Mailcode A13, Cleveland, OH, USA.
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34
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Almashat SJ, Duan L, Goldsmith JD. Non-reflux esophagitis: a review of inflammatory diseases of the esophagus exclusive of reflux esophagitis. Semin Diagn Pathol 2014; 31:89-99. [PMID: 24815935 DOI: 10.1053/j.semdp.2014.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Esophagitis is a frequent cause of clinical symptoms and is often an indication for upper endoscopy. Mucosal biopsies are procured for diagnostic purposes and may be used to assess the efficacy of treatment, as in patients with eosinophilic esophagitis. This article outlines salient clinical and pathologic features of diseases that cause esophagitis exclusive of reflux esophagitis.
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Affiliation(s)
- Salwan J Almashat
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Harvard Medical School, Boston, MA 02215
| | - Lei Duan
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Harvard Medical School, Boston, MA 02215
| | - Jeffrey D Goldsmith
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Harvard Medical School, Boston, MA 02215; Department of Pathology, Children׳s Hospital Boston, Boston, MA.
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35
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Abstract
Abnormalities of the gastrointestinal tract due to drug-induced injuries are common and often have important clinical consequences. Medications may cause damage by direct corrosive effects on mucosae or by alter processes, mucosal immunity, and local environmental conditions. The aim of this review is to guide practicing pathologists in the identification of drug-related injuries in gastrointestinal mucosal biopsies and resection specimens. Common causes of injury and their gross, endoscopic, and microscopic features are presented.
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36
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Esophageal leukoplakia or epidermoid metaplasia: a clinicopathological study of 18 patients. Mod Pathol 2014; 27:38-43. [PMID: 23765246 DOI: 10.1038/modpathol.2013.100] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 12/14/2022]
Abstract
Oral leukoplakia is a relatively common, painless disorder of the oral mucosa. It predominantly affects middle-aged to elderly men and has a strong association with tobacco smoking and alcohol intake. Concomitant histological findings of hyperorthokeratosis and a well-developed granular cell layer, termed orthokeratotic dysplasia, are often associated with oral squamous cell carcinoma. In contrast, analogous lesions within the esophagus, termed esophageal epidermoid metaplasia, are rarely encountered and poorly described in the literature. To better characterize the clinicopathological features of this entity, we have collected 25 cases from 18 patients. Patients ranged in age from 37 to 81 years (mean, 61.5 years), with a slight female predominance (10/18, 56%). On presentation, a majority of patients complained of dysphagia (10/18, 56%). Past medical history was significant for tobacco smoking or long history of second-hand smoke in 11 (61%) patients and alcohol intake in 7 (39%) patients. Seventeen (94%) patients with esophageal epidermoid metaplasia were located within the middle-to-distal esophagus. Histologically, all cases were sharply demarcated and characterized by epithelial hyperplasia, a thickened basal layer, acanthotic midzone, a prominent granular cell layer, and superficial hyperorthokeratosis. Adjacent high-grade squamous dysplasia and/or squamous cell carcinoma were seen in 3 out of 18 (17%) patients. Follow-up information was available for 13 out of 18 (72%) patients and ranged from 2 to 8.3 years (mean, 2.3 years). Seven of the 13 (54%) patients had persistent disease; however, none of them developed squamous dysplasia or squamous cell carcinoma. In an effort to assess the incidence of esophageal epidermoid metaplasia, 198 consecutive esophageal biopsies were prospectively surveyed over a 6-month period at three academic institutions. No cases were identified within this time frame. In summary, esophageal epidermoid metaplasia is a rare condition affecting the middle-to-distal esophagus in middle-aged to elderly females. The occurrence of adjacent high-grade squamous dysplasia and/or squamous cell carcinoma warrants close follow-up.
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37
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Seminerio J, McGrath K, Arnold CA, Voltaggio L, Singhi AD. Medication-associated lesions of the GI tract. Gastrointest Endosc 2014; 79:140-50. [PMID: 24119504 DOI: 10.1016/j.gie.2013.08.027] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 08/22/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Jennifer Seminerio
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christina A Arnold
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lysandra Voltaggio
- Department of Pathology, George Washington University, Washington, District of Columbia
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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38
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De Petris G, Gatius Caldero S, Chen L, Xiao SY, Dhungel BM, Wendel Spizcka AJ, Lam-Himlin D. Histopathological Changes in the Gastrointestinal Tract Due to Medications. Int J Surg Pathol 2013; 22:202-11. [DOI: 10.1177/1066896913502230] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In keeping with the stated goal of providing the surgical pathologist with tools to recognize abnormalities of the gastrointestinal (GI) tract due to drugs (AGIDS), in part II of this review we embark in a more organ-based description of AGIDS. Adequate space is given to the numerous adverse gastrointestinal effects of nonsteroidal anti-inflammatory drugs. Pill esophagitis, esophagitis dissecans, proton pump inhibitors’ effects, diaphragm disease, and the recently described effects of drugs such as olmesartan, mycophenolate, and of compounds such as yttrium-90 are highlighted among several others. The inclusion of drug effects in the differential diagnosis of “conventional” diseases (such as gastric antral vascular ectasia, graft-versus-host disease, ischemic colitis, acute colitis, collagenous enteritis, inflammatory bowel disease) is underscored to avoid sometimes significant diagnostic pitfalls. We reiterate the message of the necessary collaboration between pathologist and clinician in the recognition of these entities to provide the best patient care.
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Affiliation(s)
| | | | | | - Shu-Yuan Xiao
- University of Chicago Medical Center, Chicago, IL, USA
| | - Bal M. Dhungel
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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39
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Hart PA, Owens VL, Faubion WA. A case of esophageal pseudomembranes. Gastroenterology 2013; 145:290, 489-90. [PMID: 23806544 DOI: 10.1053/j.gastro.2013.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/26/2013] [Accepted: 04/22/2013] [Indexed: 12/02/2022]
Affiliation(s)
- Phil A Hart
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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40
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Cheng KC, Chen YL, Lai SW, Tsai PY, Sung FC. Risk of esophagus cancer in diabetes mellitus: a population-based case-control study in Taiwan. BMC Gastroenterol 2012; 12:177. [PMID: 23234272 PMCID: PMC3531311 DOI: 10.1186/1471-230x-12-177] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 12/07/2012] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes mellitus (DM) has been associated with the cancer risk. This study investigated relationship between DM and esophageal cancer using Taiwan’s insurance data. Methods We identified 549 patients with esophageal cancer newly diagnosed in 2000-2009 and randomly selected 2196 controls without any cancer, frequency matched by sex, age and diagnosis year of cases. Logistic regression model estimated odds ratios (ORs) and 95% confidence intervals (CI) of esophageal cancer associated with DM, sex, age. co-morbidities and medications. Results Cases were more prevalent than controls for alcoholism and esophageal disorders and using nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 inhibitors but not DM. Esophageal cancer had no association with DM (OR 0.99, 95% CI 0.71-1.37), but significantly associated with alcoholism (OR 14.1, 95% CI 7.87-25.4), esophageal ulcer (OR 10.1, 95% CI 5.70-17.9), esophageal reflux (OR 3.47, 95% CI 2.14-5.26) and uses of NSAIDs (OR 2.73, 95% CI 1.80-4.13). An elevated risk of esophageal cancer appeared in DM patients taking insulin (OR 2.57, 95% CI 1.08-6.15) or sulfonyurea (OR 3.80, 95% CI 1.16-12.5). Conclusions Patients with DM are not at higher risk for esophagus cancer. However, esophageal disorders and anti-diabetic drugs are associated with the risk of the disease.
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Affiliation(s)
- Kao-Chi Cheng
- Department of Family Medicine, China Medical University Hospital, Taichung404, Taiwan
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