Black esophagus: should it be considered an unfavorable prognostic factor?

Casella, Giovanni; Perego, Daniele; Corti, G; Cambareri, A. R.; Buda, C.; Zoldan, C.; Baldini, Vittorio

doi:10.1046/j.1442-2050.2001.00177.x

Cited by 18 publications

(20 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fourteen patients (28%) had coexisting diabetes mellitus. Casella et al 6 . reported that 29% of their patients with black esophagus had diabetes mellitus.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Black esophagus: report of six cases and review of the literature, 1963–2003

Grudell¹,

Mueller²,

Viggiano

2006

Diseases of the Esophagus

119

View full text Add to dashboard Cite

Black esophagus is the uncommon endoscopic finding of extensive black discoloration of the esophageal mucosa, usually from acute esophageal necrosis. Six cases of black esophagus were seen at Mayo Clinic (Rochester, Minnesota, USA) from 1997 through 2003, and 46 cases were reported in the English-language literature from 1963 through 2003. We studied the demographics, clinical features, and outcomes of these 52 cases of black esophagus. Age and sex were known for 50 patients: the mean (SD) age was 65 years (19), and 42 patients (84%) were men. Symptoms were known for 51 patients: the most common symptom was upper gastrointestinal tract bleeding, occurring in 40 patients (78%). All 52 patients had at least one comorbid condition (with most having two or more), including duodenal ulcer in 17 (33%), cancer in 15 (29%), renal insufficiency in 15 (29%), and diabetes mellitus in 14 (28%). The suspected cause of black esophagus was reported for 40 patients: ischemia in 22 (55%); massive gastroesophageal reflux in seven (18%); and esophageal infection (Lactobacillus acidophilus, herpes simplex, Candida albicans) in four (10%). Most patients received supportive therapy, particularly acid suppression therapy. Of the 47 patients for whom outcomes were known, 17 (36%) died. There were no statistically significant differences between survivors and non-survivors. Black esophagus typically occurs in older men with at least one comorbid condition; a substantial number of patients die. Although the underlying mechanism leading to black esophagus is unknown, clinicians caring for patients with black esophagus should focus on optimizing perfusion, minimizing acid reflux, and treating esophageal infection if present.

show abstract

“…Fourteen patients (28%) had coexisting diabetes mellitus. Casella et al 6 . reported that 29% of their patients with black esophagus had diabetes mellitus.…”

Section: Discussionmentioning

confidence: 98%

“…Whether ischemia was caused by hypotension 1,3,15,19 or thrombosis 4,6,16 is less clear. Notably, in Mayo Clinic patient 5, black esophagus was thought to develop because of ischemia caused by polyarteritis nodosa (Fig.…”

Section: Discussionmentioning

confidence: 99%

Black esophagus: report of six cases and review of the literature, 1963–2003

Grudell¹,

Mueller²,

Viggiano

2006

Diseases of the Esophagus

119

View full text Add to dashboard Cite

show abstract

“…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: 63%

“…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%

“…Apart from Mallory-Weiss syndrome and ruptured oesophageal varices [33], acute necrotising oesophagitis has been described as the source of fatal upper gastrointestinal bleeding in association with carcinoma of the oesophagus [1,29] and after medications had failed to transit the oesophagus and acted locally ultimately producing necrotising oesophagitis [18]. According to the literature, severe blood loss from mucosal necrosis in black oesophagus has been documented as the immediate cause of death (as verified by autopsy) in one case to date [14] and, according to clinical findings, in at least four more cases the disorder most probably influenced the fatal outcome [4,6,26], although no autopsies were performed in these cases to verify this assumption. In the present study, black oesophagus was the immediate cause of death in one case (case 5).…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Black oesophagus: a rare disorder with potentially fatal outcome

Tsokos

Herbst

2005

Int J Legal Med

View full text Add to dashboard Cite

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.

show abstract

Acute esophageal necrosis: a rare syndrome

et al. 2007

View full text Add to dashboard Cite

This study provides a structured approach to identifying risk factors, diagnosis, and pathogenesis of the acute esophageal necrosis. Risk factors include age, male sex, cardiovascular disease, hemodynamic compromise, gastric outlet obstruction, alcohol ingestion, malnutrition, diabetes, renal insufficiency, hypoxemia, hypercoagulable state, and trauma. Mechanism of damage is usually multifactorial secondary to ischemic compromise, acute gastric outlet obstruction, and malnutrition. Overall, acute esophageal necrosis should be viewed as a poor prognostic factor, associated with high mortality from the underlying clinical disease.

show abstract

Black esophagus: should it be considered an unfavorable prognostic factor?

Cited by 18 publications

References 4 publications

Black esophagus: report of six cases and review of the literature, 1963–2003

Black esophagus: report of six cases and review of the literature, 1963–2003

Black oesophagus: a rare disorder with potentially fatal outcome

Acute esophageal necrosis: a rare syndrome

Contact Info

Product

Resources

About