Black Esophagus: An Unusual Finding During Routine Endoscopy

Katsinelos, Panagiotis; Christodoulou, K.; Pilpilidis, Ioannis; Papagiannis, A.; Xiarchos, Panagiotis; Tsolkas, P.; Vasiliadis, Ioannis; Eugenidis, Nikolaos

doi:10.1055/s-2001-17333

Cited by 13 publications

(12 citation statements)

References 5 publications

(5 reference statements)

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“…alcohol abuse [16], malignancies [26], herpetic infection [7], poor nutritional status [4], immunocompromise [6] and ischemia due to cardiac pathology [13,15,25,27]. The latter five conditions can be excluded in our cases.…”

Section: Discussionmentioning

confidence: 62%

“…An erosive gastritis as additional bleeding source other than the necrosis of the oesophageal mucosa could be established by gross pathology and microscopical examination in two cases (cases 1 and 4). An association between black oesophagus and erosive gastritis has been observed endoscopically in some previously published cases, too [15,16,26]. However, we believe that the co-existence of both pathological conditions is most probably a coincidental, purely stress-related phenomenon rather than a specific pathological constellation.…”

Section: Discussionmentioning

confidence: 80%

“…The latter five conditions can be excluded in our cases. However, none of the debilitating conditions previously described in association with black oesophagus or the pathogenetic mechanisms they may induce, can satisfactorily explain the pathological findings in all cases and, accordingly, the true aetiology and exact mechanisms accounting for the development of the disease remain as yet unknown [15,16,26,27]. It remains unclear which factors may induce or influence the development of necrosis of the entire oesophageal mucosa in such a homogenous pattern as observed here in one individual suffering from a particular debilitating condition but not in the other cases.…”

Section: Discussionmentioning

confidence: 92%

“…It remains unclear which factors may induce or influence the development of necrosis of the entire oesophageal mucosa in such a homogenous pattern as observed here in one individual suffering from a particular debilitating condition but not in the other cases. In most clinical reports, the endoscopical finding of black oesophagus was completely reversible and oesophageal necrosis resolved completely with improvement of the associated disease and after supportive treatment including adequate caloric contribution, intravenous fluid administration and haemodynamic stabilisation thus reestablishing the conditions for a sufficient oesophageal blood supply [6,13,15,16,26,31]; oesophagectomy was required in only one case [12].…”

Section: Discussionmentioning

confidence: 96%

“…Most of these reports deal with the endoscopical appearance of the disease, focusing on its clinical picture and course. The knowledge of the histopathology of black oesophagus is based on a small number of microscopically examined biopsy specimens revealing mucosal necrosis and inflammation [11,15,16,26] but a detailed pathoanatomical description of the morphological correlates of this rare disorder is not available. To the best of our knowledge, only one study [14] has described the autopsy features of black oesophagus.…”

Section: Introductionmentioning

confidence: 99%

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Black oesophagus: a rare disorder with potentially fatal outcome

Tsokos

Herbst

2005

Int J Legal Med

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Black oesophagus is a rare pathological condition of unknown aetiology characterised by a full length, circumferential black discolouration of the entire oesophageal mucosa. The disease is sporadically encountered during upper gastrointestinal endoscopy. We used conventional histology, enzyme histochemistry and immunohistology to examine five autopsy cases (four males, one female; age range 43-86 years) of black oesophagus. On microscopical examination, the esophageal mucosa was entirely necrotic with demarcation by a leukocytic infiltrate in the upper submucosa. This infiltrate was dominated by neutrophilic granulocytes and scattered macrophages lacking haemosiderin deposits, placing the noxious mucosal injury in a time frame of approximately 24-72 h prior to death. Black oesophagus was established as the immediate cause of death in one case due to desanguination from the oesophagus and significantly contributed to the fatal outcome in a second case. Apart from a history of chronic alcohol consumption in four cases, no other pre-existing pathological or debilitating conditions could be established. The remarkably consistent pathomorphological picture of the disease seems to be the result of impaired microcirculation of the oesophageal mucosa due to prolonged hypotension of variable aetiology. The diagnosis of black oesophagus requires exclusion of other causes such as ingestion of caustic materials and should be based on histological examination.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Black oesophagus: a rare disorder with potentially fatal outcome

Tsokos

Herbst

2005

Int J Legal Med

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Legal and ethical considerations for genetic clinical research

Beach

Goolsby

2003

Quality Assurance Journal

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From the trend in modern medicine toward the study of genes and their contribution to the development of disease has evolved an increased awareness of ‘the diversity of genetic fingerprints among individuals’ [1]. The incorporation of this knowledge into the technologies of the pharmaceutical industry has led to the emerging field of ‘pharmacogenomics’; that is, the process of identifying the differences in genetic sequences between individuals and developing therapies [2] as ‘personal medicines’ [3]. For example, a drug used as a muscle relaxant during surgery, suxamethonium, was found to be lethal to patients who possessed a rare version of a gene involved in nerve transmission so that now those who receive this drug are tested for this specific gene [4]. Although pharmacogenomics promises great possibilities for the future of medicine, it does involve ethical and legal considerations that must be considered. Indeed, potential misuses of genetic information, such as discrimination in obtaining health insurance and in the workplace, need to be addressed. Genetic testing practices remain more advanced than the national and international laws governing the appropriate use of genetics. Although there is no national law in the United States that specifically addresses DNA and genetic privacy, several federal regulations would apply indirectly to the protection of this information and state legislators have successfully passed numerous state laws. Professional associations and private organizations have issued several guidelines for genetic testing practices. The purpose of this report is to provide a picture of the legal and ethical ramifications of genetic testing in clinical research. The genetic testing issue is presented herein in the categories of national, international, and state laws, policies, regulations and guidelines. Copyright © 2003 John Wiley & Sons, Ltd.

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Black esophagus induced by severe vomiting in a healthy young man

Katsinelos

Pilpilidis²,

Dimiropoulos³

et al. 2003

Surgical Endoscopy

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Black esophagus is an uncommon entity that has been described only a few times previously. It is defined as a dark pigmentation of the esophagus associated with histologic mucosal necrosis. Most cases have no known etiology, although ischemia, nasogastric tube trauma, infection, gastric outlet obstruction, gastric volvulus, and hypersensitivity to antibiotics have all been suggested as possible causes. Herein we report the case of a young, healthy, athletic man who developed black esophagus due to severe vomiting after alcohol overindulgence and summarize the other published cases to date.

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Black Esophagus: An Unusual Finding During Routine Endoscopy

Abstract: Figure 1 Endoscopic view of the black-appearing esophageal mucosa, with friability and exudates 904 Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.

Cited by 13 publications

References 5 publications

Black oesophagus: a rare disorder with potentially fatal outcome

Black oesophagus: a rare disorder with potentially fatal outcome

Legal and ethical considerations for genetic clinical research

Black esophagus induced by severe vomiting in a healthy young man

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