A View in the Dark: Two Cases of Acute Esophageal Necrosis in the Setting of Diabetic Ketoacidosis.

Acute esophageal necrosis (AEN), also known as Gurvits syndrome, is a rare and potentially life-threatening condition characterized by necrosis of the esophageal mucosa. Acute esophageal necrosis is often associated with critical conditions, such as myocardial infarction, diabetic ketoacidosis (DKA), coronavirus disease 2019 (COVID-19) infection, or post-surgical complications. Patients typically present with nausea, hematemesis, acute dysphagia, and melena. Given its high mortality rate, prompt detection with upper endoscopy and early initiation of treatment are crucial. Most cases of Gurvits syndrome are managed conservatively using intravenous fluids, proton pump inhibitors, and antibiotics. Herein, we present a case series of AEN in the setting of DKA. Both patients received supportive care and were discharged in a stable condition.

The modern face of esophageal candidiasis in an oncology center: Correlating clinical manifestations, endoscopic grade, and pathological data in 323 contemporary cancer patients.

OBJECTIVES: Clinical presentation and outcomes of esophageal candidiasis (EC) in cancer patients are scarcely studied in the azole era, as is the correlation between clinical, endoscopic, and histopathological EC manifestations. METHODS: We retrospectively reviewed the risk factors, clinical features, and outcomes of pathology-documented EC cases at MD Anderson Cancer Center. We further assessed associations between presence of symptoms, standardized 4-stage endoscopic grade (Kodsi classification), histopathological data, and fluconazole treatment failure. RESULTS: Among 323 cancer patients with EC, 89% had solid tumors, most commonly esophageal cancer (29%). Thirty-three percent of EC patients were asymptomatic. The proportion of symptomatic EC patients significantly increased with endoscopic grade (P = 0.005). Among 202 patients receiving oral fluconazole, 27 (13%) had treatment failure. Underlying esophageal disease was the only independent predictor of fluconazole treatment failure (odds ratio: 3.88, P = 0.005). Endoscopic grade correlated significantly with Candida organism burden (Correlation coefficient [ρ] = 0.21, P < 0.01) and neutrophilic inflammation (ρ = 0.18, P < 0.01). Candida invasion of the squamous mucosal layer was associated with treatment failure (P = 0.049). CONCLUSIONS: EC was predominantly encountered in patients with solid tumors. One-third of EC patients were asymptomatic, challenging traditional symptom-based diagnosis. The development of integrated clinicopathological scoring systems could further guide the therapeutic management of cancer patients with EC.

The dark side of the esophagus

Acute esophageal necrosis (AEN), also known as "black esophagus," is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient's underlying illness. In this article we present three cases of patients with AEN.

Dysphagia and hematemesis caused by an intramural esophageal dissection

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Esophageal lichen planus: An unusual cause of dysphagia in the elderly / Líquen plano esofágico: uma causa incomum de disfagia em idosos

Summary An 82-year-old man sought our service with dysphagia and was referred for upper endoscopy with biopsies, which evidenced multiple ulcers of the esophagus and oropharinx. Histopathology confirmed the unusual diagnosis of esophageal lichen planus. The correct clinical suspicion of this disease can facilitate the diagnosis and guide specific treatment, which can drastically change the natural course of the disease.

Resumo Paciente do sexo masculino, de 82 anos, com disfagia, foi encaminhado para realização de endoscopia digestiva alta com biópsias, na qual foram evidenciadas múltiplas úlceras de esôfago e orofaringe. O estudo histopatológico confirmou o diagnóstico raro de líquen plano esofágico. A correta suspeita clínica dessa doença pode facilitar o diagnóstico e direcionar para um tratamento específico, o que pode drasticamente alterar o curso natural dessa comorbidade.

Halitosis severa como forma de presentación de un divertículo epifrénico / Severe halitosis as presentation of epiphrenic diverticulum

La halitosis es una condición común cuya principal etiología no responde a enfermedades del sistema gastrointestinal. Los divertículos epifrénicos son una causa rara de esta manifestación, de hecho estos son poco frecuentes y suelen ser asintomáticos. Sin embargo, pueden llegar a producir síntomas con incapacidad para el paciente. Se presenta un paciente con halitosis severa, en cuyo estudio se diagnostica un divertículo epifrénico, al cual se le realizó diverticulectomía por vía laparascópica abdominal con completa resolutividad de la sintomatología (AU)

Halitosis is a common condition, whose main etiology does not respond to diseases of the gastrointestinal system. Epiphrenic diverticula are a rare cause of this manifestation, thus they are not frequent and they are usually asymptomatic. However, they may produce symptoms with inability for patient. A patient with severe halitosis is presented. In his study, an epiphrenic diverticulum is diagnosed and the laparoscopic abdominal diverticulectomy is performed with a complete resolution of symptomatology (AU)

Necrosis esofágica aguda (esófago negro) / Acute oesophageal necrosis (black oesophagus)

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Esophageal lichen planus

Abstract Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis.

Rendu-Osler-Weber syndrome: dermatological approach

The Rendu-Osler-Weber syndrome is a rare systemic fibrovascular dysplasia, recognized by mucocutaneous telangiectasias, arteriovenous malformations, epistaxis and family history. Recurrent bleeding, hypoxemia, congestive heart failure, portosystemic encephalopathy, and symptoms related to angiodysplasia of the central nervous system may occur. Since the treatment is based on supportive measures, early recognition is of utmost importance. This article reports the case of a 53-year-old male patient who presented telangiectasias on fingers, oral cavity and nasal mucosa for 10 years, with a history of recurrent epistaxis of varying severity since childhood. Mother, sister and daughter have similar lesions.

Esófago negro (necrosis aguda esofágica) / Black oesophagus (acute oesophageal necrosis)

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Long segments of columnar-lined lower esophagus are not always metaplastic

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The presence of columnar epithelium in the esophagus is associated with two conditions: Barrett’s esophagus and heterotopic gastric mucosa. The former results from the metaplastic replacement of the normal distal squamous esophageal lining, is associated with gastroesophageal reflux and is a pre-neoplastic condition. The second is thought as a congenital condition, resulting from the incomplete squamous epithelialization of the esophagus during embryologic development. It is found mainly in the cervical esophagus. Histologically, Barrett’s esophagus is composed of an admixture of cardiac mucosa, oxintocardiac mucosa and intestinal metaplasia. Most of heterotopic gastric mucosa consists of oxyntic mucosa where the mucosal glands are straight and composed of parietal and chief cells. There are few reports of heterotopic gastric mucosa in the lower esophagus, generally presenting as small islands. In the present report, a series of four cases of large lower esophageal heterotopic gastric mucosa is described. All patients were initially misdiagnosed with Barrett’s esophagus and referred for surveillance. The correct diagnosis was based in endoscopic and histological features. In all, a circular tiny strip of squamous mucosa was observed at endoscopy between the lower end of the columnarlined esophagus and the esophagogastric junction, defined as the proximal end of the gastric folds. Biopsy samples taken from the columnar-lined segments of the four patients showed pure oxyntic mucosa. When columnar-lined esophagus is observed in the distal esophagus not in continuity with gastric mucosa, the diagnosis of heterotopic gastric mucosa must be thought and confirmed histologically by the presence of pure oxyntic mucosa

Esófago negro ¿es tan malo como parece? / Black esophagus, is it as bad as it seems?

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Occupational Allergic Respiratory Disease and Eosinophilic Esophagitis by Wheat Flour in a Baker / Enfermedad respiratoria alérgica ocupacional y esofagitis eosinófila por harina de trigo en un panadero

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Prótesis esofágica autoexpansible para tratamiento de síndrome de Boerhaave: a propósito de un caso / Self-expanding esophageal stent for treatment of Boerhaave syndrome: report of a case

La perforación esofágica espontánea (PEE) o síndrome de Boerhaave es una entidad poco frecuente, consiste en la ruptura del esófago no relacionada con traumatismos, exploraciones invasivas, patología esofágica previa o cuerpos extraños. Independientemente de su mecanismo de producción, la perforación esofágica se considera como la más grave del tracto digestivo. Si su diagnóstico y reparación quirúrgica se retrasan, el pronóstico se ensombrece de forma notable. Presentamos un caso de paciente masculino de 37 años, sin antecedentes de interés que consulta a emergencia por cuadro brusco de dolor epigástrico irradiado a región retroesternal, posterior a vómito de contenido alimentario. El paciente presenta progresivamente deterioro de sus condiciones ventilatorias, que ameritan traslado a UCI y 72 horas posterior a ingreso a UCI se realizó esofagograma con bario evidenciándose extravasación de medio de contraste en tercio distal esofágico, aproximadamente 3 cm por encima de hemidiafragma izquierdo, por lo que de inmediato se decide colocación de stent metálico parcialmente cubierto Wilson-Cook (Evolution) bajo visión endoscópica y fluoroscópica, con resolución completa de la sintomatología

Spontaneous esophageal perforation (SEP) or Boerhaave syndrome is a rare entity that consists in the rupture of the esophagus unrelated to trauma, invasive examinations, previous esophageal disease or the presence of foreign bodies. Regardless of its mechanism, esophageal perforation is considered the most serious of the digestive tract. If diagnosis and surgical repair are delayed the outlook worsens considerably. We present the case of a 37-year-old male patient in good health, who attends the emergency room because of sudden onset of epigastric pain radiating to the retrosternal region after vomiting. The patient´s ventilatory condition deteriorated progressively meriting transfer to the intensive care unit; 72 hours after admission, a barium esophagram showed dye extravasation in the distal esophagus, approx 3 cm above the left diaphragm. We immediately decided to place a Wilson-Cook partially covered metal stent (Evolution) through endoscopic and fluoroscopic guidance with complete resolution of symptoms

Cambios mínimos esofágicos: ¿desapercibidos en la video endoscopia de pacientes con enfermedad de reflujo gastroesofágico no erosiva? / Esophagus minimal changes: unobserved in the video-endoscopy of patients with non erosive gastroesophageal reflux?

La mayoría de pacientes con enfermedad de reflujo gastroesofágico no tienen lesiones erosivas en esófago. Los cambios mínimos esofágicos que incluyen alteraciones blancas, rojizas, edematosas y/o acantósicas usualmente no percibidos durante la endoscopia se incluyen en Japón como parte de la enfermedad de reflujo no erosiva. Previo consentimiento se incluyeron a los individuos con síntomas de reflujo gastroesofágico y se compararon con un grupo sin éstos. Se utilizó equipo Fujinon HR250. La endoscopia se grabó en DVD y de rutina se fotografió la unión Esófago Gástrica y la Escamo Columnar. Se empleó la clasificación de Los Ángeles modificada por los japoneses que incluye Cambios Mínimos Esofágicos. Se practicó endoscopia digestiva superior en 146 pacientes 86 hombres y 60 mujeres con rango de edad 15-83 años y promedio 38,71 años. Se diferenciaron tres grupos: I) Sin cambios esofágicos, II) Con cambios esofágicos erosivos y III) Con cambios mínimos esofágicos. Los Cambios Mínimos Esofágicos se pudieron haber reportado en 53,44% y en 36,66% de pacientes con y sin síntomas de reflujo gastroesofágico respectivamente. Los Cambios Mínimos Esofágicos son frecuentes y pasan desapercibidos si no sabemos que investigar y no insistimos en buscarlos en pacientes con Enfermedad de Reflujo No Erosiva...

Most patients diagnosed with gastroesophageal reflux disease do not show erosive lesions in the esophagus. The esophagus minimal changes, which include white, reddish, edematous and/or acanthotic disturbances, are usually not perceived during endoscopic procedure and in Japan are included as part of the non erosive reflux disease. With prior consent, subjects with symptoms of gastroesophageal reflux were included, and were compared with a group without said symptoms. Fujinon HR250 equipment was used. The endoscopy was recorded on DVD and, routinely, photographs of the gastroesophageal and the squamous columnar junctions were taken. Los Angeles classification was used, as modified by the Japanese which includes Esophagus Minimal Changes. Upper digestive endoscopy was used in 146 patients: 86 men and 60 women, with ages ranging between 15 and 83, and an average of 38.71. Three groups were distinguished: I) Without changes in the esophagus; II) With erosive changes in the esophagus; and III) With esophagus minimal changes. Esophagus Minimal Changes might be reported in 53.44% and in 36.66% of patients with and without gastroesophageal reflux symptoms, respectively. Esophagus Minimal Changes are frequent but are unobserved if researcher does not know what the investigation must be on and if researcher does not insist in looking for them in patients with a diagnosis of Non Erosive Reflux Disease...