Abstract
Acute oesophageal necrosis (AON) is a rare condition characterised by the endoscopic finding of diffuse, circumferential, black mucosal pigmentation of the oesophagus, which typically stops at the gastro-oesophageal junction. This observational study aimed to assess the occurrence, clinical characteristics and outcomes of AON in a consecutive endoscopic cohort in a single tertiary university centre. A retrospective analysis of endoscopic data of upper gastrointestinal endoscopy (UGE) was carried out from 2008 to 2018. Out of 25,970 UGE, 16 patients (0.06%) had AON; 75.0% were men with a median age of 75 years. Almost all patients underwent diagnosis during emergency UGE performed for gastrointestinal bleeding, but one patient was diagnosed during elective UGE for persistent vomiting and diarrhoea. All patients reported one or more pre-existing comorbidities and concomitant acute events. Two patients had AON as the first presentation of Zollinger–Ellison syndrome (ZES). One patient developed an oesophageal stenosis, and another patient presented a relapse of AON. Mortality was 50%, but no patient died as a direct consequence of AON. AON is a rare cause of gastrointestinal bleeding diagnosed mainly during emergency UGE. Our study showed that ZES might manifest with this critical presentation, and endoscopists must be aware of this evidence.
Highlights
Acute oesophageal necrosis (AON), so-called black oesophagus, is a rare condition characterised by the endoscopic finding of diffuse, often circumferential, black mucosal pigmentation of the oesophagus, which typically stops at the gastro-oesophageal junction [1]
Our study showed that AON is a very rare condition with a prevalence of 0.06%
We found a prevalence of approximately 6%, which is quite similar to other cohorts in which the reported frequency of oesophageal stenosis has been reported in 10% of patients [5,6]
Summary
Acute oesophageal necrosis (AON), so-called black oesophagus, is a rare condition characterised by the endoscopic finding of diffuse, often circumferential, black mucosal pigmentation of the oesophagus, which typically stops at the gastro-oesophageal junction [1].Epidemiological data of AON are scant, and the prevalence of this condition is supposed to be low. Acute oesophageal necrosis (AON), so-called black oesophagus, is a rare condition characterised by the endoscopic finding of diffuse, often circumferential, black mucosal pigmentation of the oesophagus, which typically stops at the gastro-oesophageal junction [1]. AON is more frequent in elderly men with medical comorbidities, often presenting with upper gastrointestinal bleeding, ranging from haematemesis, coffee ground emesis, and melena [1,5,6]. With an overall mortality of 32% usually related to the underlying comorbidities and an estimated specific mortality of 6% [1,5,6]. It has been hypothesized that AON arises from a combination of oesophageal hypoperfusion with consequent ischaemia, impaired mucosal defence barrier and injury related to reflux of gastric contents [2].
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