Endoscopy 2007; 39: E119-E120
DOI: 10.1055/s-2006-945173
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Diffuse esophageal parakeratosis

C. H. Tu1 , C. M. Tai1 , C. Y. Chang1 , T. H. Chiang1 , C. T. Lee1 , J. T. Lin2
  • 1Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan
  • 2Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Further Information

Publication History

Publication Date:
18 April 2007 (online)

A 31-year-old woman, who suffered from chronic alcohol abuse, presented with hematemesis and loss of consciousness 2 hours after ingesting toilet bowl cleaner and sedative pills. Over the previous 6 months she had suffered worsening depressive symptoms, with increased alcohol intake, inadequate diet, and a rapid weight loss of 20 kg. An urgent endoscopy revealed extensive gastric and duodenal hemorrhage as a result of caustic injury. The esophagus was not a source of bleeding; however, it showed an unusual appearance of thick mucosa with orderly displayed rings and furrows (Figure [1] a). The furrows were particularly prominent when the lumen constricted upon irrigation (Figure [1] b). The lesion started with discrete patches at the upper esophagus (Figure [1] c), extended diffusely through the entire esophagus, and ended up at the esophagogastric junction. A section of square-shaped mucosa at the upper esophagus was peeled off by random grasping using biopsy forceps (Figure [1] d). Epithelial parakeratosis was demonstrated by microscopic examination (Figure [2]). The patient was treated with alcohol abstinence, proton-pump inhibitor, standard tube-feeding diet, and supplements of thiamine, pyridoxine, and cyanocobalamine. A follow-up endoscopy 40 days later revealed normal esophageal mucosa except for scattered candidal infections.

Figure 1 Endoscopic finding of diffuse esophageal mucosal thickening. a Thick mucosa with orderly displayed rings and furrows. b Prominent furrows during lumen constriction. c The upper esophagus showing discrete lesion patches. d Random grasping with biopsy forceps removed a square-shaped section of mucosa at the upper esophagus.

Figure 2 Biopsy of upper esophagus reveals a dense layer of parakeratosis covering the normal-appearing squamous epithelium (hematoxylin and eosin, original magnification × 100).

Diffuse esophageal hyper-/parakeratosis is an uncommon endoscopic finding. It is associated with conditions like tylosis, mucosal hyperkeratosis syndrome, and pachyonychia congenita [1]. In addition to genetic diseases, it may be linked to ethanol exposure, duodenal reflux, riboflavin deficiency, and zinc deficiency [2] [3] [4] [5]. Rapid and complete recovery after nutritional supplement in this patient suggests a causal-result relationship between them.



J. T. Lin, MD

Department of Internal Medicine

National Taiwan University Hospital

7 Chung-Shan South Road


Taiwan 10016

Fax: +886-2-23947899

Email: jawtown@ha.mc.ntu.edu.tw