Black and White Esophagus: Rare Presentations of Severe Esophageal Ischemia

Kim, Daniel B.; Bowers, Steven P.; Thomas, Mathew

doi:10.1053/j.semtcvs.2017.01.006

Cited by 13 publications

(12 citation statements)

References 6 publications

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“…Hemorrhagic shock may also result in AEN, which has been reported in association with hemodynamic compromise resulting from acute blood loss during an episode of variceal bleeding [29], rupture of a thoracic [30] or abdominal [31] aortic aneurysm, traumatic aortic transection [32] or post-surgical bleeding, for example after accidental artery laceration during orthotopic liver transplantation [33,34] or cholecystectomy [35].…”

Section: Etiologymentioning

confidence: 99%

“…It may be related to a combination of poor nutritional status, reduced lower esophageal sphincter pressure and increased volume of gastric secretions [78]. Some patients presenting with AEN who have a history of chronic alcoholism also have chronic liver disease, including cirrhosis [22,34,46,47,79,80], a known risk factor for AEN, or earlier hepatic changes, including milder forms of liver disease fibrosis [12,20] or steatosis [55,56]. In addition, AEN may be triggered by acute alcohol abuse [16,20,45,47], perhaps as a result of severe vomiting causing damage to esophageal mucosa [16], or low systemic pressure associated with hypothermia [45] or alcoholic lactic acidosis [47].…”

Section: Etiologymentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and management of acute esophageal necrosis

Dias

Santos-Antunes

Macedo

2019

aog

113

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Acute esophageal necrosis is a rare syndrome classically characterized by a striking endoscopic image of diffuse and circumferential black mucosal discoloration of distal esophagus, with an abrupt transition at the gastroesophageal junction and variable proximal extension. The typical patient is an older male with general debilitation and multiple comorbidities presenting with hematemesis or melena. The pathophysiology usually involves a combination of esophageal ischemia, backflow injury from gastric chemical contents and impaired mucosal reparative mechanisms associated with debilitated physical states. It may arise in the setting of hemodynamic compromise, diabetic ketoacidosis, hypothermia, alcoholic intoxication, trauma, inflammatory diseases, esophageal local infection, solid organ transplantation, postoperative status, drugs or acute gastric outlet obstruction, usually in the background of a chronic debilitating process, where the concurrent presence of multiple risk factors, including diabetes mellitus, hypertension, malnutrition, malignancy or alcohol abuse, places a patient at higher risk. The characteristic endoscopic appearance establishes the diagnosis. Biopsy is supportive but not required. Management is mainly supportive and consists of correcting coexisting conditions, fluid therapy, bowel rest, intravenous proton pump inhibitor therapy and red blood cell transfusion as needed. Although this is a serious life-threatening condition, appropriate treatment may result in a favorable outcome in the majority of patients.

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Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Diagnosis and management of acute esophageal necrosis

Dias

Santos-Antunes

Macedo

2019

aog

113

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“…Of these cases, we managed to extract data from 79 articles having 105 cases of AON (online supplementary table 1). 5–82 Data could not be extracted from (n=13) of the articles containing a total of (n=20) cases 4 83–95. The most common reasons for these were unavailability of complete data or the language being other than English.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive review of acute oesophageal necrosis

Ullah¹,

Mehmood

Micaily

et al. 2019

BMJ Case Rep

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Acute oesophageal necrosis, also known as ‘black oesophagus’, is a rare condition characterised by the black discolouration of the oesophageal mucosa on endoscopy and involves the distal oesophagus in majority of cases but may also extend proximally. A number of conditions are found to be associated with it and it is thought to occur due to a combination of hypovolaemia and inadequate oesophageal protective mucosal barrier function. Gastric secretions may have a direct effect on the oesophageal mucosa. We present a case of a woman who presented with haematemesis and significant hypotension after a session of haemodialysis. Black oesophagus was confirmed on esophagogastroduodenoscopy. She was given two units of packed red blood cells and one unit of platelets, and started on a pantoprazole infusion. However, despite rigorous attempts at resuscitation the patient failed to recover.

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“…Kim et al insisted that both black and white esophagus originated from ischemic injury of the esophagus. [25] Ischemic insults of the esophagus is a major etiology of AEN. [6] The present study showed no difference in the comorbidities between black and white color changes of AEN, except for malignancy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of prognostic factor and nature of acute esophageal necrosis

et al. 2019

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Acute esophageal necrosis (AEN) is a serious disease which can causes gastrointestinal bleeding and death. Although black color change is not essential factor of organ necrosis, AEN is also known as “black esophagus.” Because of its rarity, there are limited studies regarding risk factors of mortality and recurrence. Thus, we conducted a multicenter retrospective study in order to evaluate the clinical characteristics of AEN. Method Clinical datum of AEN patients from 7 tertiary hospitals located in Daejeon-Choongcheong province were evaluated based on medical records. Our primary endpoint was risk factors for mortality and the secondary endpoint was risk factors for recurrence and clarifying whether “black esophagus” is a right terminology.Fourty one patients were enrolled. Thirty six patients were male, mean age was 69.5 years. Nine patients had died, and 4 patients showed recurrence. Sepsis and white color change in endoscopy were related to high mortality (Chi-Squared test, P < .05). Old age, high pulse rate, low hemoglobin, and low albumin were also related to high mortality. Unexpectedly, heavy drinking showed favorable a mortality. Septic condition and high pulse rate showed poor mortality in logistic regression test (P < .05). Coexisting duodenal ulcer was related to recurrence (Chi-Squared test, P < .05). There was no difference in the underlying condition except patients with a coexisting cancer and white-form displayed lower hemoglobin level. Conclusion: Our results imply that white color change, septic condition, high pulse rate, and low hemoglobin & albumin are poor prognostic factors in AEN. Further evaluation may help clarify the findings of our study.

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Black and White Esophagus: Rare Presentations of Severe Esophageal Ischemia

Cited by 13 publications

References 6 publications

Diagnosis and management of acute esophageal necrosis

Diagnosis and management of acute esophageal necrosis

Comprehensive review of acute oesophageal necrosis

Evaluation of prognostic factor and nature of acute esophageal necrosis

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