Amit R. Hudgi, MBBS1, Shreyans Doshi, MD1, Isaac E. Perry, DO2, Steven B. Ellison, MD2; 1Augusta University Medical Center, Augusta, GA; 2Medical College of Georgia, Augusta, GA
Introduction: Esophageal thermal injury (ETI) is a rare phenomenon caused by mucosal injury with the ingestion of hot food. Here we report one such case who presented with a sensation of food bolus and later found to have ulceration of the esophageal lining with no oropharyngeal injury.
Methods: A 32 years-old male patient with no significant past medical history presented with a sensation of food bolus which started soon after consuming his meal six hours ago. He denied any oral discomfort or ulceration, pain with swallowing, and/or hematemesis. His examination was insignificant for any abnormality. No oral ulcer or congestion was noted. Esophago-gastro duodenoscopy (EGD) was performed to evaluate for impacted food or esophageal injury. Esophageal erosions were found at 30cms and 36cms respectively with characteristic “Candy cane” appearance, biopsies were obtained from the lesions. Mild gastritis was also noted. Of note, no oral or upper esophageal congestion or erosions were appreciated. The biopsy revealed ulcerative esophagitis with reactive epithelial atypia likely secondary to thermal injury from the ingested hot food. The patient was started on a liquid diet which he tolerated well. He was prescribed tablet pantoprazole 40mg BID for 8 weeks. Discussion: Acute Esophageal thermal injury refers to insults caused by the ingestion of hot food to the esophageal mucosa. It usually presents with dysphagia, odynophagia, and/or chest discomfort. Odynophagia is almost always present in cases of esophageal thermal injury. Our case only had a sensation of food bolus in the esophagus. High clinical suspicion and elaborate history elicitations are helpful in detecting esophageal injury. Characteristic endoscopic findings include alternating bands of, linear erythema and whitish pseudomembranous lesions giving an appearance of a “candy cane”. This is an early esophageal finding and the appearance of the lesion differs depending on the size of the particle, liquid or solid state of food, degree of injury, and time since insult. The prognosis of AEI is favorable and is usually treated conservatively with avoidance of hot food, proton pump inhibitors, and/or sucralfate to prevent further injury to the mucosa.
Esophageal injury noted at 30cms with characteristic “Candy Cane” appearance.
Esophageal ulceration noted at 36cms .
Disclosures: Amit Hudgi indicated no relevant financial relationships. Shreyans Doshi indicated no relevant financial relationships. Isaac Perry indicated no relevant financial relationships. Steven Ellison indicated no relevant financial relationships.