Smit Deliwala, MD1, Brandon T. Wiggins, DO, MPH2, Anoosha Ponnapalli, MD1, Murtaza Hussain, MD1, Thulasi Beere, MD3, Lalida Kunaprayoon, MD1, Harini Lakshman, MD1, Michele Obeid, MD1, Areeg Bala, MD1, Grigoriy Gurvits, MD, FACG4; 1Hurley Medical Center, Flint, MI; 2Ascension Genesys Hospital, Grand Blanc, MI; 3Hurley Medical Center, Grand Blanc, MI; 4New York University Langone Medical Center, New York, NY
Introduction: Acute Esophageal Necrosis (AEN) is a rare syndrome characterized by a diffuse necrotic black appearing mucosa preferentially affecting the distal esophagus with various proximal extensions and an abrupt demarcation at the GE junction. Its etiology is multifactorial, a combination of ischemic injury, massive reflux of gastric contents, and impaired esophageal mucosal defense systems. AEN incidence is 0.01 to 0.28% in selected studies, and population-based information regarding AEN is sparse. Presentation in literature is typically based on published reports, but scientific abstracts are often overlooked. We aim to present a systematic review of a large number of previously presented abstracts from 2010 to 2020 ACG annual meetings. Methods: We identified all ACG published abstracts over the past ten years using "acute esophageal necrosis" OR "black esophagus" OR "acute necrotizing esophagitis" across databases (Figure 1). Results: Amongst 89 abstracts, 97 patients were identified. Mean age was 63.68 ± 14 years, while 65% were males. Most common presenting features were hematemesis (34%), melena (22%), coffee-grounded emesis (16%), abdominal pain (11%), dysphagia (9%) and odynophagia (6%). Risk factors included diabetes mellitus (39%), CKD (33%), HTN (32%), cirrhosis (25%), alcohol use (23%), CAD (18%) and cancer (18%). Patients received an EGD within 3.41 ± 10.34 days from symptom onset. Over 95% of cases were confirmed visually on endoscopy and remaining on autopsy. Affected segments were middle-distal (34%), pan-esophageal (28%), distal (20%), middle (5%), while proximal was seen in less than 1%. Histology findings uniformly confirmed necrosis, although biopsies were not performed in 54%. Majority received medical management with PPIs (80%), antibiotics (43%), and sucralfate (12%). Patients treated medically remained NPO for 5 ± 2.52 days, with 9% receiving TPN. Follow-up endoscopies were seen in 32%, with a mean of 31.84 ± 64.95 days. Majority demonstrated significant improvement, with complete resolution in 10%, as early as 3 days. Complications included perforation (18%), strictures (5%) and infections (4%), and a mortality rate of 23%. Discussion: AEN syndrome is increasingly being reported as awareness increases, with the majority of all ACG abstracts being published over the past decade. Patients with chronic diseases are more commonly afflicted. Endoscopy is diagnostic. Increased awareness of the disease may lead to a rise in prevalence.
Figure 1 - PRISMA flowsheet for black esophagus trends across ACG scientific meetings from 2010 - 2020
Disclosures: Smit Deliwala indicated no relevant financial relationships. Brandon Wiggins indicated no relevant financial relationships. Anoosha Ponnapalli indicated no relevant financial relationships. Murtaza Hussain indicated no relevant financial relationships. Thulasi Beere indicated no relevant financial relationships. Lalida Kunaprayoon indicated no relevant financial relationships. Harini Lakshman indicated no relevant financial relationships. Michele Obeid indicated no relevant financial relationships. Areeg Bala indicated no relevant financial relationships. Grigoriy Gurvits indicated no relevant financial relationships.