Digestive Diseases and Sciences

, Volume 60, Issue 7, pp 2049–2057 | Cite as

Esophagitis Dissecans Superficialis: Clinical, Endoscopic, and Histologic Features

  • Phil A. Hart
  • Ryan C. Romano
  • Roger K. Moreira
  • Karthik Ravi
  • Seth SweetserEmail author
Original Article



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


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


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.


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).


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.


Sloughing esophagitis Intraepithelial splitting Parakeratosis Esophageal membrane 



Esophagitis dissecans superficialis


Esophageal lichen planus


Eosinophilic esophagitis


Non-steroidal anti-inflammatory drug


Serotonin and norepinephrine reuptake inhibitor


Serotonin receptor uptake inhibitor


Tricyclic antidepressant

JEL Classification

6.7: non-reflux esophageal disorders 6.5: EGD: NSAIDs, clinical studies 22.1: EGD; upper endoscopy 


Conflict of interest


Supplementary material

10620_2015_3590_MOESM1_ESM.tif (3.2 mb)
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 (174 kb)
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)


  1. 1.
    Beck RN. Oesophagitis dissecans superficialis. Br Med J. 1954;1:501–502.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Cameron RB. Esophagitis dissecans superficialis and alendronate: case report. Gastrointest Endosc. 1997;46:562–563.PubMedCrossRefGoogle Scholar
  3. 3.
    Perez-Carreras M, Castellano G, Colina F, et al. Esophagitis dissecans superficialis (esophageal cast) complicating esophageal sclerotherapy. Am J Gastroenterol. 1998;93:655–656.PubMedCrossRefGoogle Scholar
  4. 4.
    Purdy JK, Appelman HD, McKenna BJ. Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa. Mod Pathol. 2012;25:767–775.PubMedCrossRefGoogle Scholar
  5. 5.
    Kaplan RP, Touloukian J, Ahmed AR, Newcomer VD. Esophagitis dissecans superficialis associated with pemphigus vulgaris. J Am Acad Dermatol. 1981;4:682–687.PubMedCrossRefGoogle Scholar
  6. 6.
    Cesar WG, Barrios MM, Maruta CW, et al. Oesophagitis dissecans superficialis: an acute, benign phenomenon associated with pemphigus vulgaris. Clin Exp Dermatol. 2009;34:e614–e616.PubMedCrossRefGoogle Scholar
  7. 7.
    Hage-Nassar G, Rotterdam H, Frank D, Green PH. Esophagitis dissecans superficialis associated with celiac disease. Gastrointest Endosc. 2003;57:140–141.PubMedCrossRefGoogle Scholar
  8. 8.
    Albert DM, Ally MR, Moawad FJ. The sloughing esophagus: a report of five cases. Am J Gastroenterol. 2013;108:1816–1817.PubMedCrossRefGoogle Scholar
  9. 9.
    Carmack SW, Vemulapalli R, Spechler SJ, Genta RM. Esophagitis dissecans superficialis (“sloughing esophagitis”): a clinicopathologic study of 12 cases. Am J Surg Pathol. 2009;33:1789–1794.PubMedCrossRefGoogle Scholar
  10. 10.
    Hokama A, Ihama Y, Nakamoto M, et al. Esophagitis dissecans superficialis associated with bisphosphonates. Endoscopy. 2007;39(Suppl 1):E91.PubMedCrossRefGoogle Scholar
  11. 11.
    Longman RS, Remotti H, Green PH. Esophagitis dissecans superficialis. Gastrointest Endosc. 2011;74:403–404.PubMedCrossRefGoogle Scholar
  12. 12.
    Ponsot P, Molas G, Scoazec JY, et al. Chronic esophagitis dissecans: an unrecognized clinicopathologic entity? Gastrointest Endosc. 1997;45:38–45.PubMedCrossRefGoogle Scholar
  13. 13.
    Coppola D, Lu L, Boyce HW Jr. Chronic esophagitis dissecans presenting with esophageal strictures: a case report. Hum Pathol. 2000;31:1313–1317.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Phil A. Hart
    • 1
    • 2
  • Ryan C. Romano
    • 3
  • Roger K. Moreira
    • 3
  • Karthik Ravi
    • 1
  • Seth Sweetser
    • 1
    Email author
  1. 1.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  2. 2.Division of Gastroenterology, Hepatology, and NutritionThe Ohio State University Wexner Medical CenterColumbusUSA
  3. 3.Department of PathologyMayo ClinicRochesterUSA

Personalised recommendations