Carle Foundation Hospital Champaign, IL, United States
Tapasya Raavi, MBBS, MPH1, Jemin Jose, MBBS2, Pavan Mankal, MD2 1Carle Foundation Hospital, Champaign, IL; 2Carle Foundation Hospital, Urbana, IL
Introduction: Esophagitis dessicans superficialis (EDS), also known as ‘sloughing esophagitis’ is a rare condition characterized by sloughing of large fragments of esophageal mucosa. EDS is usually associated with medications causing ‘pill induced esophagitis’, autoimmune conditions like (celiac disease, lupus, bullous pemphigoid, and pemphigus vulgaris), chemical irritants, hot beverages, heavy smoking, rarely infectious etiologies, and is sometimes idiopathic.
Case Description/Methods: A patient in her fifties presented with complaints of melena, a few episodes of non-bloody, non-bilious emesis, and bilateral lower quadrant abdominal pain. There were no complaints of fever, chills, hematemesis, or hematochezia. She had a medical history significant for dysphagia, esophageal dilatation, gastroesophageal reflux disease, gastritis, hepatic cysts, infectious colitis, melanosis coli, sigmoid diverticulosis, end stage renal disease and anemia of chronic disease. She was hypotensive (blood pressure 83/50 mm Hg) and anemic (hemoglobin 8.2 g/dL) on arrival, was resuscitated with isotonic fluids, started on proton pump inhibitors and then underwent an upper endoscopy. The endoscopy showed severe esophagitis with sloughing of the superficial layer of the mid esophagus with no bleeding, which was reported as ‘likely esophagitis dissecans superficialis’. Two non-bleeding gastric ulcers with adherent hematin were also seen and hemostatic clips were placed. Biopsy of the esophageal lesions showed desquamated epithelium with prominent superficial surface involvement by fungal yeast suggestive of Candida species. She was treated with fluconazole, continued antacids, and was recommended to repeat upper endoscopy in two months.
Discussion: EDS often presents with symptoms of dysphagia, odynophagia, coughing or vomiting up of chunks of sloughed mucosa, hematemesis, melena, or weight loss. Upper endoscopy with esophageal biopsies remains the mainstay of diagnosis for EDS. Biopsy usually shows sloughed superficial epithelium with parakeratosis and varying degrees of inflammation. Despite the dramatic presentation, it is usually a benign condition that resolves with removal of the offending agent in addition to treatment with proton pump inhibitors and adequate hydration. In cases where autoimmune conditions are the cause, addition of steroids to the treatment would be of help. A repeat endoscopy after six to eight weeks is recommended in all cases to ensure healing.
Figure: Esophageal lumen showing desquamated and sloughed epithelium in the mid esophagus.
Tapasya Raavi indicated no relevant financial relationships.
Jemin Jose indicated no relevant financial relationships.
Pavan Mankal indicated no relevant financial relationships.
Tapasya Raavi, MBBS, MPH1, Jemin Jose, MBBS2, Pavan Mankal, MD2. P1401 - Esophagitis Dessicans Superficialis in a Patient With Esophageal Candida Infection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.