Oesophagitis Dissecans in a Child With Vomiting

Abstract

Oesophagitis dissecans superficialis (ODS), referred to as “sloughing oesophagitis,” is a rare finding of unknown aetiology and unclear significance. Some cases have been vomited tubular casts of oesophageal mucosa (1), but often ODS is an unsuspected finding. The endoscopist notices whitish strips of peeling oesophageal mucosa, similar to those seen in eosinophilic oesophagitis. Histology shows intraepithelial splitting of squamous epithelium above the basal layer, typically with no or minimal inflammation (2). Superficial fragments may have fungal or bacterial colonies (2). Multiple small bullae and neutrophil microabscesses involving the middle layers of the epithelium have been described (2). Bullous skin disorders and bisphosphonate therapy are associated with ODS; however, most cases remain unexplained (2–4). We treated a 14-year-old girl with a history of effortless, nonbilious vomiting. There was no abdominal pain, dyspepsia, or weight loss. She had multiple allergies and elevated immunoglobulin E. Investigations, including fluoroscopy, gastric emptying, and magnetic resonance imaging of the brain, were normal. She was not taking any medications. Endoscopic and histological findings were consistent with the diagnosis of ODS. Because to our knowledge, ODS has never been reported in children, the endoscopic appearance (Figs. 1–3) may be different than that classically described in adults.FIGURE 1: Bacterial colonies on luminal surface (1). Flaking of superficial squamous epithelium (2). Bullous inflammation (3).FIGURE 2: Lower oesophagus.FIGURE 3: Mid-oesophagus.As recommended in the literature, a proton pump inhibitor was given (1,2). The literature indicates good prognosis with complete resolution on follow-up endoscopy (2,5). Our case showed full endoscopic and histological resolution.