Ferrous Sulfate-Induced Esophageal Injury Leading to Esophagitis Dissecans Superficialis

Abstract

Medication-induced esophagitis is a well-known but relatively rare clinical diagnosis, most common in patients with preexisting esophageal dysmotility, obstruction, or altered anatomy. Esophagitis dissecans superficialis (EDS) is a rare endoscopic finding characterized by sloughing of large fragments of the esophageal mucosal lining. The causes of EDS include prior trauma, heavy smoking history, ingestion of alcoholic and hot beverages, and immunosuppression. We present a unique case of EDS secondary to ferrous sulfate-induced pill esophagitis. The patient was a 94-year-old male who presented with dysphagia to solids, odynophagia, and weight loss. Esophagogastroduodenoscopy (EGD) revealed EDS. Biopsies demonstrated vacuolar degeneration at the midlevel of the epithelium with overlying hyperkeratosis and parakeratosis, with noted black/brown pigment present at the level of the split in the epithelium. The patient was started on a liquid diet with no oral administration of pills. EGD was repeated and showed a significant improvement in esophageal mucosa and resolution of strictures. Although medication-induced esophagitis is not classically associated with EDS, specific circumstances that are associated with pill esophagitis may lead to progression to EDS. In the Case

Esophagitis Dissecans Superficialis After Thermal Injury

“…This mechanism is proposed, given prior associations of this condition with other known esophageal irritants, such as nonsteroidal anti-inflammatory drugs, bisphosphonates, and oral iron. 5 We established the diagnosis of EDS rather than acute esophageal thermal injury (ETI) based on the symptoms, endoscopy findings, and biopsy histology observed in this case. Our patient was asymptomatic, while ETI is typically associated with dysphagia, odynophagia, and chest pain.…”

“…This mechanism is proposed, given prior associations of this condition with other known esophageal irritants, such as nonsteroidal anti-inflammatory drugs, bisphosphonates, and oral iron. 5…”

“…This esophageal lesion has been reported in association with desquamating dermatological disorders, physical trauma, chemical irritants, anticoagulants, and immunotherapies. [1][2][3][4][5][6][7] Furthermore, EDS has been observed more frequently in debilitated patients. 8 Endoscopic presentation of EDS typically involves whitish strips of easily detachable esophageal mucosa underlined by normal-appearing mucosa.…”

Esophagitis Dissecans Superficialis: Unveiling the Enigmatic Entity of Esophageal Mucosal Sloughing

“…Our patient was presented with complaints of dysphagia only. EDS is commonly seen in the distal and middle third of the esophagus; it has the potential to affect the entire length of the esophagus [12]. The diagnosis of EDS is by endoscopy, which reveals the characteristic appearance of sloughed mucosal fragments, along with the biopsy to confirm the diagnosis and rule out other possible conditions.…”

Gastrointestinal Hemorrhage From Esophageal Dissecans Superficialis After the Initiation of a Tyrosine Kinase Inhibitor

“…Esophagitis dissecans superficialis (EDS) or sloughing esophagitis is a rare and benign disorder which is characterized by the sloughing of the esophageal mucosa [1]. EDS was first described by Dr. L. Rosenberg in 1892 as peeling of the squamous mucosa of the esophagus with regurgitation of esophageal casts [2]. An incidence of 0.03% has been reported; it predominantly affects adults > 50 years old [3,4].…”