Acute esophageal necrosis: Black esophagus in setting of diabetic ketoacidosis

Abstract

Introduction: Acute esophageal necrosis (AEN) is a rare cause of upper gastrointestinal bleeding with an unclear etiology that may be related to ischemic insults resulting in caustic injury primarily to the distal segment of the esophagus along with damage caused by underlying coronary artery disease or diabetes mellitus. If not diagnosed correctly, treatment may incorrectly focus on proton pump rather than underlying medical conditions which if not addressed, can lead to repeat episodes of the condition. case report: We report a case in which a patient presented in diabetic crises. Esophagogastroduodenoscopy (EGD) revealed circumferential necrotic discoloration and friable tissue of the gastroesophageal junction with a normal appearing stomach. treatment with a proton pump inhibitor and aggressive insulin management led to cessation of symptoms. conclusion: Upper gastrointestinal bleeding is a common complaint in both the inpatient and outpatient settings. While many cases may be related to bacterial infection (Helicobacter pylori) or iatrogenic insults (NsAID or alcohol use), rare cases may be related to poorly controlled underlying medical conditions such Brooke Colin Bear1, Jacob Mathew1, Calvin W. Parker III2 Affiliations: 1Resident Physician, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA; 2Gastroenterologist, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA. Corresponding Author: Brooke Colin Bear, 1 Jarrett White Road, Honolulu, HI USA, 96859-5000, 808-433-6641; Fax: 808-433-1556; Email: brooke.c.bear.civ@mail.mil Received: 06 May 2015 Accepted: 25 August 2015 Published: 01 December 2015 as coronary artery disease or diabetes. Our case highlights the need to keep heightened suspicion for entities such as AEN in patients who have appropriate underlying medical conditions to prevent further episodes.