Background and Study Aims: Acute necrotizing esophagitis is a rarely described entity. Its incidence has not
yet been established, and its multifactorial etiology remains unknown. The aim of
the present study was to establish the incidence, clinical presentation, endoscopic
course, accompanying factors, and pathogenesis of the condition.
Patients and Methods: A retrospective analysis of clinical, laboratory, endoscopic and histological data
and the clinical course in 29 patients with acute necrotizing esophagitis was carried
out over a 5-year period.
Results: Acute necrotizing esophagitis was observed in 29 of 10 295 upper gastrointestinal
endoscopies (0.28 %) carried out during the 5-year period. The average age of the
patients was 75.24 years (range 40 - 91), and they were predominantly male. Eighty-three
percent of the patients had comorbid conditions. In all cases, acute necrotizing esophagitis
became evident with upper gastrointestinal bleeding, without hemodynamic stabilization
in the majority of cases (75.9 %). The lesions predominantly affected the lower two-thirds
of the esophagus (59 %), and there were coexisting abnormal endoscopic findings in
83 % of cases. Empirical supportive therapy, including oral nutritional rest, omeprazole,
sucralfate (15 cases) and broad-spectrum antibiotics (7 cases) was provided. The condition
resolved in all patients. Ten patients in the group died of other causes (coexisting
illnesses).
Conclusions: Acute necrotizing esophagitis was more commonly recognized than has previously been
reported. It is a serious clinical entity that should be considered in the differential
diagnosis of upper gastrointestinal bleeding, particularly in elderly patients. The
prognosis depends more on the patient’s advanced age and on comorbid illnesses than
on the course of the esophageal lesions, which resolved in all patients in this series.
References
- 1
Dalgaard J B.
Oesophago-gastro-duodenal ulcerations encountered at autopsy.
Acta Pathol Microbiol Scand.
1957;
41
1-18
- 2
Brennan J L.
Case of extensive necrosis of the oesophageal mucosa following hypothermia.
J Clin Pathol.
1967;
20
581-584
- 3
Lee K R, Stark E, Shaw F E.
Esophageal infarction complicating spontaneous rupture of the thoracic aorta.
JAMA.
1997;
237
1233-1234
- 4
Goldenberg S P, Wain S L, Marignani P.
Acute necrotizing esophagitis.
Gastroenterology.
1990;
98
493-496
- 5
Cummings D R.
Acute necrotizing esophagitis [letter].
Gastroenterology.
1990;
99
1193-1194
- 6
Tuso P, Marignani P.
Necrotizing duodenitis: a stress-associated lesion?.
J Clin Gastroenterol.
1990;
12
29-32
- 7
Mangan T F, Colley A T, Wytock D H.
Antibiotic-associated acute necrotizing esophagitis [letter].
Gastroenterology.
1990;
99
900
- 8
Benhaim-Iseni M C, Brenet P, Petite J M.
Acute necrotizing esophagitis: another case [letter].
Gastroenterology.
1991;
101
281
- 9
Goldenberg S P, Wain S L, Marignani P.
Reply to Benhaim-Iseni MC, Brenet P, Petite JP.
Gastroenterology.
1991;
101
281-282
- 10
Robert J Y, Raoul J L, Bretagne J F. et al .
L’oesophage noir. Trois nouveaux cas.
Gastroenterol Clin Biol.
1993;
17
298-301
- 11
Langle C, Cadiot G, Calvat S. et al .
Deux cas d’ ”oesophage noir” découverts lors d’une acidocétose diabétique grave.
Gastroenterol Clin Biol.
1994;
18
176-177
- 12
Gargot D, Causse X, Sapey T. et al .
L’oesophage noir: un nouveau cas associé à une hépatite hypoxique.
Gastroenterol Clin Biol.
1994;
18
177-179
- 13
Haviv Y S, Reinus C, Zimmerman J.
”Black esophagus”: a rare complication of shock.
Am J Gastroenterol.
1996;
91
2432-2434
- 14
Moretó M, Ojembarrena E, Zaballa M. et al .
Idiopathic acute esophageal necrosis: not necessarily a terminal event.
Endoscopy.
1993;
25
534-538
- 15
Erdozain J C, Herrera A, Molina E. et al .
Idiopathic acute esophageal necrosis: a report of a new case.
Endoscopy.
1994;
26
713
- 16
Augusto F, Fernandes V, Cremers M I. et al .
Esofagite necrosante aguda: análise de sete casos.
Arq Hepatogastrenterol Port.
1998;
7
19-26
- 17
Macedo G, Correia A, Maia J. et al .
Black esophagus.
Am J Gastroenterol.
1998;
93
855-856
- 18
Freitas J, Fonseca J, Fonseca C. et al .
Esofagite aguda necrosante idiopática: análise de oito casos.
J Port Gastroenterol.
1998;
5
243-248
- 19
Obermeyer R, Kasirajan K, Erzurum V. et al .
Necrotizing esophagitis presenting as a black esophagus.
Surg Endosc.
1998;
12
1430-1433
- 20
Cattan P, Cuillerier E, Cellier C. et al .
Black esophagus associated with herpes esophagitis.
Gastrointest Endosc.
1999;
49
105-107
- 21
Lacy B, Toor A, Bensen S. et al .
Acute esophageal necrosis: report of two cases and a review of the literature.
Gastrointest Endosc.
1999;
49
527-532
- 22
Benoit R, Grobost B.
Black esophagus related to acute esophageal necrosis: a new case.
Presse Méd.
1999;
28
1509-1512
- 23
Reichart M, Busch O R, Bruno M J. et al .
Black esophagus: a view in the dark.
Dis Esophagus.
2000;
13
311-313
- 24
McManus J P, Webb J N.
A yeast-like infection of the esophagus caused by Lactobacillus acidophilus.
Gastroenterology.
1975;
68
583-586
- 25
Etienne J P, Roge J, Delavierre P. et al .
Nécroses de l’oesophage d’origine vasculaire.
Sem Hôp Paris.
1969;
45
1599-1606
M. I. Cremers, M. D.
Dept. of Gastroenterology · Hospital de S. Bernardo
Av. Camilo Castelo Branco · 2910 Setúbal · Portugal
Fax: +351-265-549070
Email: Cremers_Tavares@hotmail.com
