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Esophagitis Dissecans Superficialis: Clinical, Endoscopic, and Histologic Features

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Abstract

Background

Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the esophagus, but there is a paucity of the literature regarding this condition.

Aim

We examined our institution’s experience to further characterize clinical outcomes, and endoscopic and histopathologic features.

Methods

Endoscopy and pathology databases were retrospectively reviewed from 2000 to 2013 at Mayo Clinic Rochester to identify potential cases of EDS. Medical records and endoscopic images were reviewed to identify cases, and original pathologic specimens were also reviewed. Clinical, endoscopic, and histologic characteristics of EDS were defined.

Results

Forty-one subjects were identified with a median age at diagnosis of 65.0 years (IQR 52.8–76.1) and a female preponderance (63.4 %). Many patients were taking a psychoactive agent (73.1 %) or acid-suppressive therapy (58.5 %) preceding the index endoscopy. Strips of sloughed membranes had a predilection for the distal and/or middle esophagus and resolved in 85.7 % of subjects at endoscopic follow-up. Parakeratosis and intraepithelial splitting were histologic features seen in all patients, while splitting of the connective tissue and intraepithelial bullae were seen in 46.2 and 11.1 %, respectively. There were no disease-related complications at a median follow-up of 10.4 months (IQR 1.2–17.2).

Conclusions

EDS is likely under-recognized. A distinct endoscopic feature of EDS is “sloughing” strips of mucosa with parakeratosis and intraepithelial splitting being sine qua non histologic findings. The use of psychoactive agents (particularly a SSRI or SNRI) was prevalent at endoscopic diagnosis, although the clinical relevance of this is uncertain. EDS appears to be a benign, incidental finding without complications.

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Abbreviations

EDS:

Esophagitis dissecans superficialis

ELP:

Esophageal lichen planus

EoE:

Eosinophilic esophagitis

NSAID:

Non-steroidal anti-inflammatory drug

SNRI:

Serotonin and norepinephrine reuptake inhibitor

SSRI:

Serotonin receptor uptake inhibitor

TCA:

Tricyclic antidepressant

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Conflict of interest

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Phil A. Hart, Karthik Ravi & Seth Sweetser

  2. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Phil A. Hart

  3. Department of Pathology, Mayo Clinic, Rochester, MN, USA

    Ryan C. Romano & Roger K. Moreira

Authors
  1. Phil A. Hart
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  2. Ryan C. Romano
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  3. Roger K. Moreira
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  4. Karthik Ravi
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  5. Seth Sweetser
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Corresponding author

Correspondence to Seth Sweetser.

Electronic supplementary material

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10620_2015_3590_MOESM1_ESM.tif

The evolution of intraepithelial cystic degeneration is shown in panels A-D. Small cystic spaces are seen between the layer of parakeratosis and the superficial epithelium (A). Cystic spaces may evolve into longitudinal clefts with intact, yet fragile intercellular bridges (B). Cysts continue to expand and may fill with debris, separating superficial epithelium from basal layer (C). Large cysts above the basal layer, devoid of significant inflammation, are commonly observed (D) (hematoxylin and eosin stain, A-D; original magnification: A, x20; B-D, X40) (TIFF 3241 kb)

10620_2015_3590_MOESM2_ESM.doc

Exhaustive list of medications used use during the 30 days preceding the index upper endoscopy in 41 subjects with esophagitis dissecans superficialis. The sum of individual medications does not always equal the medication category subtotal due to potential the use of multiple medications within the same class (DOC 173 kb)

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Hart, P.A., Romano, R.C., Moreira, R.K. et al. Esophagitis Dissecans Superficialis: Clinical, Endoscopic, and Histologic Features. Dig Dis Sci 60, 2049–2057 (2015). https://doi.org/10.1007/s10620-015-3590-3

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  • DOI: https://doi.org/10.1007/s10620-015-3590-3

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