Acute Esophageal Necrosis: An In-depth Review of Pathogenesis, Diagnosis and Management

Abu B Sheikh; Samir Mirza; Ramsha Abbas; Nismat Javed; Anthony Nguyen; Hamza Hanif; Asif Farooq

doi:10.55729/2000-9666.1020

Acute Esophageal Necrosis: An In-depth Review of Pathogenesis, Diagnosis and Management

J Community Hosp Intern Med Perspect. 2022 Jan 31;12(1):96-103. doi: 10.55729/2000-9666.1020. eCollection 2022.

Authors

Abu B Sheikh¹, Samir Mirza², Ramsha Abbas³, Nismat Javed³, Anthony Nguyen¹, Hamza Hanif⁴, Asif Farooq⁵

Affiliations

¹ University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA.
² Dow Medical School, Department of Internal Medicine, Karachi, Pakistan.
³ Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
⁴ University of New Mexico Health Sciences Center, Department of General Surgery, Albuquerque, NM, USA.
⁵ Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA.

Abstract

Introduction: Acute esophageal necrosis (AEN) is an uncommon but fatal cause of upper gastrointestinal bleeding. The complex pathophysiology of the disorder provides multiple points for intervention. Therefore, it is important to discuss the many multifaceted aspects of the disease.

Methods: A scoping review was performed using PubMed, Google Scholar, and ClinicalTrials.gov. We reviewed literature from 1990 to 2021. The keywords used were 'acute esophageal necrosis', 'upper GI bleed', 'pathogenesis', 'EGD', 'prognosis'.

Results and conclusions: The review summarized findings of 46 studies. AEN usually targets older males who have underlying cardiovascular disease. The middle part of the esophagus is commonly involved. The pathogenesis of AEN depends on conditions that increase risk of mucosal damage such as ischemia, lack of mucosal protection and excessive gastric reflux. Some medications are also responsible for the disease. Esophagogastroduodenoscopy is usually the gold standard for diagnosis. Findings suggestive of AEN include darkened, sharply demarcated circumferential areas. Supportive measures, including bowel rest, fluid supplementation and proton pump inhibitors are the cornerstone of therapy. A high index of suspicion should be maintained in patients with chronic health problems presenting with signs and symptoms of upper gastrointestinal bleeding because AEN can carry an unfavorable prognosis in these patients.

Keywords: Acute esophageal necrosis; EGD; pathogenesis; prognosis; upper GI bleed.

Publication types

Review