Esophageal Hyperkeratosis in a Healthy Adult

Kisloff, Barry; McGrath, Kevin; Davison, Jon M.

doi:10.1016/j.cgh.2011.01.015

Cited by 8 publications

(6 citation statements)

References 3 publications

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“…However, clinical histories of GORD were also given in almost half (46%) of the non‐BO‐associated hyperkeratosis group. Gastric or bilious reflux has been reported in single patients with oesophageal hyperkeratosis or leucoplakia due to parakeratosis, and a rat model study in which oesophagus was surgically anastomosed to duodenum demonstrated that reflux of gastroduodenal juice resulted almost universally in hyperkeratosis . Interestingly, there is evidence that GORD can facilitate squamous injury – including leucoplakia – to the head and neck region as well as oesophagus.…”

Section: Discussionmentioning

confidence: 99%

“…Vitamin replacement in that child led to endoscopic and histological improvement in just 4 months. Other cases of oesophageal hyperkeratosis have been attributed to smoking in conjunction with alcohol use, chronic gastro‐oesophageal reflux disease (GORD) and tylosis, an autosomal dominant disease associated with hyperkeratosis of palms and soles and increased risk for squamous carcinoma of the oesophagus.…”

Section: Introductionmentioning

confidence: 99%

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Oesophageal hyperkeratosis: clinicopathological associations

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oesophageal hyperkeratosis: clinicopathological associations

et al. 2013

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“…Their hypothesis was based on an earlier observation made by Pera et al [ 5 ] in an animal model regarding the presence of pancreatic enzymes in the duodenogastric refluxate leading to differentiation in the squamous epithelium. In 2011 Kisloff et al documented significant hyperkeratosis in a patient with a five-year history of gastroesophageal reflux disease (GERD) on a twice-daily PPI regimen [ 6 ]. The patient had “mild intraepithelial eosinophilia” without dysplasia and was negative for human papillomavirus infection (HPV) or fungal causation, which led to their conclusion that the hyperkeratosis was caused by reflux.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Esophageal Hyperkeratosis: A Rare Case Presentation

Choudhry¹,

Jd²,

Choudhry³

et al. 2023

Cureus

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Diffuse esophageal hyperkeratosis (DEH) is a very intriguing and impressive mucosal finding that is quite easily identified on endoscopy and histology. A distinction must be made between microscopic/focal hyperkeratosis and endoscopically visible DEH. Microscopic hyperkeratosis is not uncommon in histological studies, while diffuse hyperkeratosis is seen very rarely. Over the past century, only a handful of cases have been reported. The endoscopic appearance of hyperkeratosis is of thick, white, piled-up mucosa. On histology, there is a prominent thickening of the stratum corneum, the squamous cells are anuclear, and there is no hyperplasia of the squamous epithelium. These histological characteristics distinguish benign orthokeratotic hyperkeratosis from other premalignant entities such as parakeratosis or leukoplakia where hyperplastic squamous cells retain pyknotic nuclei, lack keratohyalin granules, and also lack complete keratinization in superficial epithelial cells. The clinical presentation of hyperkeratosis includes gastroesophageal reflux, hiatal hernia, and associated symptoms. Our case highlights a very rare endoscopic finding associated with a common clinical presentation. The nearly 10-year follow-up reinforces the benign nature of ortho-hyperkeratosis and our report underscores the features that distinguish DEH from premalignant conditions. It merits additional research into factors that lead to hyperkeratinization of the esophageal mucosa as opposed to the more common columnar metaplasia. The concomitant presence of Barrett’s esophagus in some patients is even more intriguing. Animal models with variable pH and content of the refluxate may shed light on the role played by duodenogastric/non-acid reflux in this condition. Larger, prospective, multicenter studies may provide the answers.

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“…In contrast, the keratinized stratified squamous epithelium was observed in the first case, and minimal inflammatory cell infiltration was observed. Furthermore, esophageal hyperkeratosis also presents as a white plaque-like lesion [ 18 ]; therefore, the increased thickness of the keratinized stratified squamous epithelium could have been endoscopically observed as white plaques. These differences in pathological features might have caused the differences in endoscopic images between the two patients; magnifying observation could reveal tiny white depositions in the first patient (Figures 3B , 3C ) and multiple small white membranous lesions in the second patient (Figures 6C , 6D ).…”

Section: Discussionmentioning

confidence: 99%

Multiple White Plaques in the Esophagus: A Possible Case of Esophageal Mucosal Alteration Associated With Immune-Related Adverse Events of Immune Checkpoint Inhibitors

Iwamuro¹,

Tanaka²,

Kono³

et al. 2022

Cureus

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We report two cases of multiple white plaques in the esophagus that emerged after the administration of immune checkpoint inhibitors. Both patients developed enterocolitis as immune-related adverse events associated with immune checkpoint inhibitors. Esophagogastroduodenoscopy revealed duodenal involvement and multiple white plaques in the esophagus. A biopsy of the esophagus showed predominant CD3 + lymphocyte infiltration, suggesting that esophageal mucosal alterations were associated with immune-related adverse events. In addition, histopathology showed keratinized stratified squamous epithelium in the first case while increased inflammatory cell infiltration in the intraepithelial and subepithelial layers was observed in the second case. These data suggest a different pathogenesis of the multiple esophageal white plaques between the two cases. Although further investigation is needed to elucidate the significance of these observations, recognition of the esophageal plaques may be important for prompt diagnosis of immune-related adverse events when associated with immune checkpoint inhibitors.

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Esophageal Hyperkeratosis in a Healthy Adult

Cited by 8 publications

References 3 publications

Oesophageal hyperkeratosis: clinicopathological associations

Oesophageal hyperkeratosis: clinicopathological associations

Diffuse Esophageal Hyperkeratosis: A Rare Case Presentation

Multiple White Plaques in the Esophagus: A Possible Case of Esophageal Mucosal Alteration Associated With Immune-Related Adverse Events of Immune Checkpoint Inhibitors

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