Clinical presentations, management, and outcomes of acute esophageal necrosis: a systemic review

ABSTRACT

Background: To review all the reported literature on acute esophageal necrosis.

Research methods: Databases were searched using the special Medical Subject Heading (MeSH) terms. All the available reported cases of acute esophageal necrosis were analyzed.

Results: A total of 154 cases were identified and 130 cases were analyzed. The mean age of presentation was 61 years, and 70% of cases were males. The most common presenting symptoms were hematemesis in 66%, shock in 36%, melena in 33%, abdominal or substernal pain in 28%. The most common comorbidities reported were diabetes in 38%, hypertension in 37%, alcohol abuse in 25%, and chronic kidney disease in 16%. On upper endoscopy, 51% had a distal disease, 36% had pan esophageal, and only 2% had a proximal disease. 84% of patients were treated with IV Proton Pump Inhibitors, 22% received transfusions, 23% got antibiotics for underlying sepsis, 14% also received sucralfate, and 4% required surgery for treatment. The mortality rate was 32%, while perforation was reported in 5% and stricture formation reported in 9% of patients.

Conclusions: Patients with acute esophageal necrosis can have a favorable outcome if treated appropriately.

KEYWORDS:

• Acute esophageal necrosis
• acute necrotizing esophagitis
• black esophagus
• esophageal necrosis

Article highlights

• Acute esophageal necrosis (AEN) also commonly called ‘black esophagus’ and ‘ acute necrotizing esophagitis’ is a condition in which part or whole of the esophagus, develops necrosis. It is a life threatening condition with a high mortality rate.

• It is a disease of predominantly the elderly population, with many patients having risk factors for AEN. Its pathogenesis usually involves underlying comorbidities along with some inciting event like shock.

• Diagnosis is established with endoscopy with characteristic findings of black discoloration of the esophagus. A biopsy is usually done to rule out infections and other etiologies.

• Although acute esophageal necrosis is considered a serious life-threatening condition, appropriate symptomatic treatment, and acid suppression result in a favorable outcome in over 60% of patients.

• Some patient may inevitably develop immediate or long term complications like perforation or esophageal stenosis.

Author contributions

H.M. Abdullah, W. Ullah, M. Abdallah, U. Khan were involved in the initial literature search, data extraction, and manuscript writing. A. Hurairah and M. Atiq helped in data analysis and critical review of the manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

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Additional information

Funding

This paper was not funded.