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Coseru AI, Ciortescu I, Nemteanu R, Barboi OB, Floria DE, Vulpoi RA, Strungariu DG, Ilie SI, Rosca V, Drug VL, Plesa A. Apixaban-Induced Esophagitis Dissecans Superficialis-Case Report and Literature Review. Diseases 2024; 12:263. [PMID: 39452506 PMCID: PMC11506947 DOI: 10.3390/diseases12100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 09/29/2024] [Accepted: 10/19/2024] [Indexed: 10/26/2024] Open
Abstract
Novel direct oral anticoagulants (DOACs) are prescribed worldwide in the treatment of non-valvular atrial fibrillation. Adverse reactions have been reported following the use of DOACs. One notable trend in the literature is the growing number of reported cases of esophagitis dissecans superficialis (EDS) generated by DOAC use. We hereby report the case of a 73-year-old woman who presented to the hospital with asthenia, dysphagia, and melena two days prior to admission. The patient had taken apixaban due to non-valvular paroxysmal atrial fibrillation for a few weeks. The biological panel showed moderate anemia with a hemoglobin level of 7.7 g/dL Apixaban-induced EDS was diagnosed by the characteristic endoscopic findings. The patient received treatment with a proton pump inhibitor (pantoprazole) in a double dose. Also, an iron treatment was recommended for a period of six months. The follow-up endoscopy at one month confirmed the healing of the esophageal lesions. The case was discussed with the cardiologist. The first anticoagulant treatment proposed after discharge was a vitamin K antagonist (acenocumarol) but the patient refused this medication and thus it was decided to initiate rivaroxaban. Although DOACs have demonstrated their efficacy in the prevention and treatment of stroke and thromboembolism among the aging demographic, cases of DOAC-induced EDS will continue to pose numerous challenges for physicians worldwide.
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Affiliation(s)
- Alexandru Ionut Coseru
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
| | - Irina Ciortescu
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Roxana Nemteanu
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Oana-Bogdana Barboi
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Diana-Elena Floria
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Radu-Alexandru Vulpoi
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Diana Georgiana Strungariu
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
| | - Sorina Iuliana Ilie
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
| | - Vadim Rosca
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Vasile-Liviu Drug
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
| | - Alina Plesa
- Gastroenterology and Hepatology Institute, “Saint Spiridon” University Hospital, 700111 Iasi, Romania; (A.I.C.); (I.C.); (O.-B.B.); (D.-E.F.); (R.-A.V.); (D.G.S.); (S.I.I.); (V.R.); (V.-L.D.); (A.P.)
- Medical I Department, University of Medicine and Pharmacy “Grigore. T. Popa”, 700115 Iasi, Romania
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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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Zaher EA, Patel P, Zaher D. Esophagitis Dissecans Superficialis: A Case Report. Cureus 2023; 15:e44372. [PMID: 37779763 PMCID: PMC10540652 DOI: 10.7759/cureus.44372] [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: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Esophagitis dissecans superficialis (EDS) is a rare esophageal lesion characterized by sloughing of the esophageal mucosa. Typically asymptomatic and histopathologically nonspecific, diagnosis relies on endoscopic appearance. We report a case of an 81-year-old female who presented with an 8-pound weight loss in two weeks. Upper endoscopy showed severe mucosal changes with sloughing in the lower esophagus, consistent with EDS. Histopathology confirmed the diagnosis. No offending agents were identified, and high-dose proton pump inhibitors (PPIs) were initiated, resulting in symptom improvement. EDS remains poorly understood; it is associated with medication use, esophageal motility disorders, and autoimmune conditions. EDS should be considered in unexplained weight loss cases, with treatment focused on the discontinuation of culprits and PPI therapy.
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Affiliation(s)
- Eli A Zaher
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Parth Patel
- Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Daria Zaher
- Department of Internal Medicine, University Clinical Hospital in Białystok, Białystok, POL
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Salehi AM, Salehi H, Hasanzarrini M. Esophagitis Dissecans Superficialis after COVID-19; A Case Report. Middle East J Dig Dis 2022; 14:346-348. [PMID: 36619272 PMCID: PMC9489431 DOI: 10.34172/mejdd.2022.293] [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: 08/18/2021] [Accepted: 03/12/2022] [Indexed: 11/06/2022] Open
Abstract
Esophagitis dissecans superficialis (EDS) is an uncommon disease characterized by esophageal mucosal sloughing. EDS is a benign condition that usually resolves without residual pathology. Medication, chemical irritants, hot drinks, and autoimmune diseases have all been associated with EDS. Here a 60-year-old lady with post-COVID-19 EDS is presented. Her chief complaint was dysphagia and odynophagia for 2 weeks duration. EDS diagnosis was based on endoscopic findings and biopsy. Her problem was improved by a high dose of pantoprazole.
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Affiliation(s)
- Amir Mohammad Salehi
- Medical Student, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossain Salehi
- Gastroenterology Ward, Baharlo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Hasanzarrini
- Assistant professor of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran,Corresponding Author: Maryam Hasanzarrini, MD Assistant Professor of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Address: Hamadan University of Medical Sciences, Shahid Fahmideh street, postal code: 6517838838 Telefax: +98 0813131000
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Shaikh OH, Gaur NK, Vijayakumar C, Kumbhar US. Regurgitation and prolapse of oesophageal mucosa: a dramatic presentation of the oesophagitis dissecans superficialis. BMJ Case Rep 2022; 15:e249006. [PMID: 35318207 PMCID: PMC8943745 DOI: 10.1136/bcr-2022-249006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/04/2022] Open
Abstract
Oesophagitis dissecans superficialis is a rare benign entity that is usually self-limited, characterised by sloughing of the oesophageal mucosa. We preset a 38-year-old woman, known case of epidermolysis bullosa acquisita who presented to us with regurgitation and prolapse of the oesophageal mucosa from the mouth. Upper gastrointestinal endoscopy showed sloughing of the mucosa. The patient was managed conservatively and discharged.
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Affiliation(s)
- Oseen Hajilal Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, Pondicherry, India
| | - Naveen Kumar Gaur
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, Pondicherry, India
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, Pondicherry, India
| | - Uday Shamrao Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, Pondicherry, India
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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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Esophagitis dissecans superficialis (EDS) secondary to esophagogastric junction outflow obstruction (EGJOO): a case report and literature review. Clin J Gastroenterol 2020; 14:26-31. [PMID: 33001361 DOI: 10.1007/s12328-020-01247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Esophageal dissecans superficialis (EDS) is a rare disease with endoscopic findings of sloughing squamous tissue with underlying normal mucosa and had no known cause. The literature does support possible causality between the presence of an esophageal stricture and EDS however there has been no association to date between EDS and esophagogastric junction outflow obstruction (EGJOO). We present a case of newly diagnosed EGJOO in a patient with long standing gastroesophageal reflux disease who presented with dysphagia. Evaluation identified endoscopically normal mucosa and a diagnosis of esophagogastric junction outflow obstruction on high resolution impedance manometry. A month later, repeat endoscopy identified diffusely sloughing mucosa consistent with EDS. Endoscopic dilation followed by a robotic Heller myotomy with Dor fundoplication to relive the outflow obstruction resulted in resolution of EDS in this case.
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