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

J. T. Lin, MD

Department of Internal Medicine

National Taiwan University Hospital

7 Chung-Shan South Road

Taipei

Taiwan 10016

Fax: +886-2-23947899

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

Publication History

Publication Date:
18 April 2007 (online)

Table of Contents

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.

Zoom Image

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.

Zoom Image

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.

Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH

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References

J. T. Lin, MD

Department of Internal Medicine

National Taiwan University Hospital

7 Chung-Shan South Road

Taipei

Taiwan 10016

Fax: +886-2-23947899

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

#

References

J. T. Lin, MD

Department of Internal Medicine

National Taiwan University Hospital

7 Chung-Shan South Road

Taipei

Taiwan 10016

Fax: +886-2-23947899

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

Zoom Image

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.

Zoom Image

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