Endoscopy 2007; 39: E305
DOI: 10.1055/s-2007-966789
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

A relapse case of acute necrotizing esophagitis

K.  Tanaka1 , H.  Toyoda1 , Y.  Hamada2 , M.  Aoki2 , R.  Kosaka2 , T.  Noda2 , M.  Katsurahara2 , M.  Nakamura2 , K.  Ninomiya2 , H.  Inoue2 , I.  Imoto1 , Y.  Takei2
  • 1Department of Endoscopic Medicine, Mie University School of Medicine, Tsu, Japan
  • 2Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Japan
Further Information

Publication History

Publication Date:
24 October 2007 (online)

Acute necrotizing esophagitis (ANE) is a severe form of acute esophagitis that appears dark black in color (”black esophagus”) at endoscopy due to mucosal necrosis [1]. ANE is an uncommon condition of unknown etiology. Grudell et al. reported that among 52 cases of ANE, seven cases involved massive gastroesophageal reflux [2]. As gastroesophageal reflux is one of the proposed causes of ANE [3] [4], treatment generally includes administration of a proton pump inhibitor (PPI).

A 67-year-old man complained of vomiting and chest pain 5 days after surgery for a vitreous hemorrhage. The patient had a history of diabetes mellitus, hypertension, hyperlipidaemia, and angina pectoris. Endoscopy revealed a black-appearing esophageal mucosa extending from the proximal two thirds of the esophagus to the cardia ([Fig. 1]). After 6 days of treatment that included oral nutritional rest for 1 week and rabeplazole (20 mg/day), the mucosal surface was diffusely covered with whitish exudates ([Fig. 2]), and biopsy specimens consisted of necrotic debris. By continuing to take rabeplazole for 4 months after release from hospital, the patient was cured of esophagitis ([Fig. 3]). However, 37 days after finishing the rabeplazole treatment, the patient returned due to recurring vomiting and chest pain. Endoscopy revealed a reoccurrence of the black-appearing esophageal mucosa and whitish exudates, as well as mucosal bleeding ([Fig. 4]). Upon reestablishment of the treatment described previously, the relapsed ANE improved considerably within 3 weeks. With continued administration of rabeplazole, the ANE has not relapsed.

Fig. 1 Endoscopy revealed a black-appearing esophageal mucosa extending from the proximal two thirds of the esophagus to the cardia.

Fig. 2 After 6 days of treatment, the esophageal surface was diffusely covered with whitish exudates.

Fig. 3 By continuing to take rabeplazole for 4 months after release from hospital, the patient was cured of esophagitis.

Fig. 4 The patient returned 37 days after finishing the rabeplazole treatment, and endoscopy revealed a reoccurrence of the black-appearing esophageal mucosa and whitish exudates, as well as mucosal bleeding.

To our knowledge, this is the first reported case of a relapse of ANE [2] [5]. In this case, relapse may have been associated with acid backflow, and we hypothesize that if the patient were to discontinue the PPI, he would experience another relapse.

Endoscopy_UCTN_Code_CCL_1AB_2AC_3AD

References

K. Tanaka, MD

Department of Endoscopic Medicine

Mie University School of Medicine

2-174 Edobashi

Tsu

Mie

514-8507 Japan

Fax: + 81-59-231-5200

Email: kyosuket@qa2.so-net.ne.jp