Black esophagus: an uncommon cause of upper gastrointestinal bleeding
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‘Black esophagus’ or acute esophageal necrosis (AEN) was first described by Goldenberg et al. in the early 1990s [1, 2]. The incidence of black esophagus is very low, ranging from 0.012 to 0.2 %, and according to the literature, 90 cases have been reported so far [3, 4]. The etiology is unknown in most cases. Most investigators have suggested an ischemic origin. Risk factors include advanced age, male gender, cardiovascular disease, alcoholic ingestion and malnutrition, acute gastric outlet obstruction with gastro-esophageal reflux, diabetes, acute renal failure and trauma. Candidiasis is a rare cause of AEN. An incidental finding in upper endoscopy has also been mentioned . The esophagus has a black-appearing color, with easily crumbled mucosa predominantly affecting the lower two-thirds of the esophagus. Esophageal transit with barium swallow shows if there is any potential of an esophageal motility disorders, and computed tomography (CT scan) may reveal a thickened distal esophagus, a hiatal hernia, and a distended fluid-filled stomach with possible gastric outlet obstruction. Endoscopic biopsies show epithelial necrosis, with non-specific inflammatory exudates, and ulcerations. Esophageal bleeding (melena and hematemesis) is the most common presentation. The differential diagnosis of black esophagus includes: the ingestion of corrosive agents, infections, esophageal melanosis and pseudomelanosis, acanthosis nigricans and coal-dust miner. The main reported complications of AEN are stenosis and strictures. Regarding the therapeutic approach, most authors recommend adequate hydration, the use of a proton pump inhibitor, sucralfate, and treating the esophageal infection, if present. Additionally, treating the patient’s comorbidities such as restoration of the iron adequacy, and elimination of any esophageal infection as well as abstinence from alcohol, which may have been an aggravating factor. The prognosis is usually hopeful if other comorbidities do not influence the outcome.
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Conflict of interest
The authors declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committees, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human and animals performed by any of the authors.
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