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Acute esophageal necrosis, also known as black esophagus or acute necrotizing esophagitis is a rare condition with roughly 154 cases reported in the literature. This condition is classically diagnosed on its endoscopic findings of a circumferentially black esophagus that abruptly ends at the gastroesophageal junction and transitions to normal gastric mucosa. When present, acute esophageal necrosis potentially signifies a poor prognosis with an overall mortality up to 36%. This case report describes a critically ill patient with multiple comorbidities that was found to have acute esophageal necrosis the entire length of the esophagus secondary to ischemia/hypoperfusion that was caused by diabetic ketoacidosis. The patient had a prolonged hospitalization but was ultimately discharged in stable condition. We also review the literature of this rare esophageal condition.

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Background: Medication reconciliation (MR) on admission has potential to reduce negative patient outcomes. The objectives of this prospective observational study were to 1) measure the impact a hospital-wide MR program has on home medication error identification at hospital admission, 2) demonstrate cost-effectiveness of this program, and 3) identify risk factors placing individual patients at higher risk for medication discrepancies. Methods: Technicians obtained medication histories on adult patients admitted to the hospital that managed their own medications. Frequency and type of medication errors were recorded. Cost avoidance estimations were determined based on expected adverse drug event rates. Logistic regression analysis was used to test for associations between medication errors and patient characteristics. Results were considered significant when p-value was less than 0.05. Results: The study included 817 patients. Technicians recorded a mean of 6.1 medication discrepancies per patient (SD ± 0.4) and took 28.5 minutes (SD ± 1.2 minutes) to complete a medication history. Omission, commission, and dosing/frequency errors occurred in 82%, 59%, and 50% of medication histories, respectively. We estimated cost avoidance of $210.33 per patient with this program. Female gender, age, and high alert/risk medication use were linked to an increase in the likelihood of occurrence of a medication discrepancy. Conclusion: This study validated the ability of a pharmacy technician to identify errors, demonstrated economic cost-effectiveness, provided new data on time to obtain a BPMH, and further identified factors that contribute to the occurrence of medication discrepancies. Potentially harmful medication discrepancies were identified frequently on admission. With further research, it may be possible to identify those at highest risk for home medication discrepancies upon admission.

Esophageal squamous papillomas are rare epithelial lesions typically discovered incidentally during EGD. Their prevalence is estimated to be less than 0.01% in the general population. We present three cases of esophageal squamous papillomas identified histologically. It may be possible to identify these lesions macroscopically. One study provided a positive predictive value of 88% for squamous papilloma utilizing the triad of exophytic growth, wart-like projections, and surface vessel crossing seen on narrow band imaging during endoscopy. The etiology is unclear. Chronic mucosal irritation from GERD or esophagitis is the prevailing theory of pathogenesis, but HPV has been detected in some lesions. The malignant potential of these lesions is considered controversial. There are documented cases demonstrating complications with squamous cell carcinoma, so we recommend removal of all esophageal squamous papillomas; however, the small absolute number of cases documented in the literature makes drawing any associations or conclusions between esophageal squamous papillomas and squamous cell carcinoma difficult. Further research is needed regarding treatment and surveillance. This case series helps contribute to the small but growing literature of this rare finding.

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