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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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Tang L, Luo R, Wu Z, Yang J, Deng K. Esophageal mucosa exfoliation: a rare case during endoscopic submucosal dissection. Gastroenterol Rep (Oxf) 2024; 12:goae007. [PMID: 38390579 PMCID: PMC10882261 DOI: 10.1093/gastro/goae007] [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: 12/09/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- Li Tang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Rong Luo
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Zhihan Wu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Jinlin Yang
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Kai Deng
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Sichuan University, Chengdu, Sichuan, P. R. China
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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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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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