Abstract
Background
Acute necrotizing esophagitis (ANE) is a rarely described entity that is thought to be a cause of upper gastrointestinal (UGI) bleeding, The present study examined the incidence of ANE among patients with UGI bleeding, as well as the clinical features of ANE, and the coexisting illnesses and medication histories of ANE patients.
Methods
A retrospective analysis of clinical and endoscopic findings and the clinical course in 16 patients with ANE was carried out over a 3-year period.
Results
We observed 16 patients (6%) of ANE in 239 patients with UGI bleeding during the 3-year period. The average age of the patients was 62.5 years. The lesions predominantly affected the lower third of the esophagus, and hiatal hernia was the most common (63%) coexisting endoscopic finding. All patients had coexisting disease. Fifty percent of patients with ANE (eight patients) had taken nonsteroidal anti-inflammatory drugs (NSAIDs). ANE also occurred in four patients with diabetic ketoacidosis. Supportive therapy, including parenteral nutrition and administration of a proton pump inhibitor, was effective.
Conclusions
ANE is more common than has been previously reported, and it should be included in the differential diagnosis of UGI bleeding. ANE could be characterized as an “acute esophageal mucosal lesion,” particularly in aged patients with hiatal hernia and among those who consume NSAIDs.
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References
C Sugawa D Benishek (1983) ArticleTitleMallory-Weiss syndrome Am J Surg 145 30–3 Occurrence Handle10.1016/0002-9610(83)90162-9 Occurrence Handle1:STN:280:BiyD1MfhsVE%3D Occurrence Handle6600377
DM Jensen (2002) ArticleTitleEndoscopic screening for varices in cirrhosis: findings, implications, and outcomes Gastroenterology 122 1620–30 Occurrence Handle10.1053/gast.2002.33419 Occurrence Handle12016427
SP Goldenberg SL Wain P Marignani (1990) ArticleTitleAcute necrotizing esophagitis Gastroenterology 98 493–6 Occurrence Handle1:STN:280:By%2BC3cfls1w%3D Occurrence Handle2295407
M Moreto E Ojembarrena M Zaballa JG Tanago S Ibanez (1993) ArticleTitleIdiopathic acute esophageal necrosis: not necessarily a terminal event Endoscopy 25 534–8 Occurrence Handle1:STN:280:ByuC3MnkslI%3D Occurrence Handle8287816 Occurrence Handle10.1055/s-2007-1009121
P Cattan E Cuillerier C Cellier F Carnot B Landi A Dusoleil et al. (1999) ArticleTitleBlack esophagitis associated with herpes esophagitis Gastrointest Endosc 49 105–7 Occurrence Handle10.1016/S0016-5107(99)70455-4 Occurrence Handle1:STN:280:DyaK1M%2FovVSjug%3D%3D Occurrence Handle9869733
F Augusto V Fernandes MI Cremers AP Oliveira C Lobato AL Alves et al. (2004) ArticleTitleAcute necrotizing esophagitis: a large retrospective case series Endoscopy 36 411–5 Occurrence Handle10.1055/s-2004-814318 Occurrence Handle1:STN:280:DC%2BD2c3gt1Sktw%3D%3D Occurrence Handle15100949
MM Wolfe DR Lichtenstein GS Singh (1999) ArticleTitleGastrointestinal toxicity of nonsteroidal anti-inflammatory drugs N Eng J Med 340 1888–99 Occurrence Handle10.1056/NEJM199906173402407 Occurrence Handle1:CAS:528:DyaK1MXktFKrtbs%3D
SR Heller MG Fellows AL Ogilvie et al. (1982) ArticleTitleNon-steroidal anti-inflammatory drugs and benign esophageal stricture Br Med J 285 167–8 Occurrence Handle1:STN:280:DyaL383jt1OqsQ%3D%3D Occurrence Handle10.1136/bmj.285.6336.167
WE Wilkins MG Ridley AL Pozniak (1984) ArticleTitleBenign stricture of the oesophagus: role of non-steroidal anti-inflammatory drugs Gut 25 478–80 Occurrence Handle1:STN:280:DyaL2c7otlOltQ%3D%3D Occurrence Handle6714790
HB El-Serag A Sonnenberg (1997) ArticleTitleAssociation of esophagitis and esophageal strictures with diseases treated with nonsteroidal anti-inflammatory drugs Am J Gastroenterol 92 52–6 Occurrence Handle1:STN:280:ByiC2cbht10%3D Occurrence Handle8995937
EL Semble WC Wu DO Castell (1989) ArticleTitleNonsteroidal anti-inflammatory drugs and esophageal injury Semin Arthritis Rheum 19 158–62 Occurrence Handle10.1016/0049-0172(89)90054-1
B Avidan A Sonnenberg TG Schnell SJ Sontag (2001) ArticleTitleRisk factors for erosive reflux esophagitis: a case–control study Am J Gastroenterol 96 41–6 Occurrence Handle10.1111/j.1572-0241.2001.03449.x Occurrence Handle1:STN:280:DC%2BD3M7gslGmtw%3D%3D Occurrence Handle11197285
H Makuuchi (1982) ArticleTitleClinical study of esophageal hiatal hernia Jpn J Gastroenterol 79 1557–67 Occurrence Handle1:STN:280:BiyD1cnktVY%3D
JC Mason (1999) ArticleTitleNSAIDs and the oesophagus Eur J Gastroenterol Hepatol 11 369–73 Occurrence Handle1:CAS:528:DC%2BD3cXit1yjtg%3D%3D Occurrence Handle10321751
D Alber C Moussard M Toubin JC Henry Y Ottingnon JP Deschamps (1988) ArticleTitleGas chromatographic/mass spectrometric quantitative analysis of eicosanoids in human esophageal mucosa Biomed Environ Mass Spectrom 16 299–304 Occurrence Handle10.1002/bms.1200160157 Occurrence Handle1:STN:280:BiaB3cjosV0%3D Occurrence Handle3149537
JM Scheiman PM Patel EK Henson TT Nostrant (1995) ArticleTitleEffect of naproxen on gastroesophageal reflux and esophageal function: a randomized, double-blind, placebo-controlled study Am J Gastroenterol 90 754–7 Occurrence Handle1:STN:280:ByqB2M%2FnsFU%3D Occurrence Handle7733082
AD Purushotham GR Gray DT Hansell (1991) ArticleTitleProstaglandins in the treatment of reflux esophagitis: double-blind placebo controlled clinical trial J R Coll Surg Edinb 36 216–8 Occurrence Handle1:STN:280:By2D2crmsFc%3D Occurrence Handle1941733
SS Shirazi WL Zike M Brubacher L DenBesten (1974) ArticleTitleEffect of aspirin, alcohol and pepsin on mucosal permeability of esophageal mucosa Surg Forum 25 335–7
DO Faigel DC Metz (1996) ArticleTitlePrevalence, etiology, and prognostic significance of upper gastrointestinal hemorrhage in diabetic ketoacidosis Dig Dis Sci 41 1–8 Occurrence Handle10.1007/BF02208576 Occurrence Handle1:STN:280:BymC28%2Fnt10%3D Occurrence Handle8565740
Diabetic ketoacidosis. In: Pickup UC, Williams G, editors. Textbook of diabetes, 2nd ed. Oxford: Blackwell Science; 1997
D Katz HI Siegel (1968) Erosive gastritis and acute gastric mucosal lesion GB Glass (Eds) Progress in gastroenterology, vol. 1 Grune and Stratton New York 67–96
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Yasuda, H., Yamada, M., Endo, Y. et al. Acute necrotizing esophagitis: role of nonsteroidal anti-inflammatory drugs. J Gastroenterol 41, 193–197 (2006). https://doi.org/10.1007/s00535-005-1741-6
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DOI: https://doi.org/10.1007/s00535-005-1741-6