S3562 A Rare Case of Esophageal Dissecans Superficialis Occurring With Barrett's Esophagus

Abstract

Introduction: Esophageal dissecans superficialis (EDS) is a rare desquamative disorder of the esophagus characterized by sloughing of the superficial mucosa. Less than 200 cases of EDS are reported worldwide. The pathogenesis is poorly understood. We present a case of EDS in the setting of Barrett’s esophagus (BE). The association of EDS with BE has not been previously reported. Case Description/Methods: The patient is a 66-year-old male with a history of hypertension, chronic obstructive pulmonary disease, and atrial fibrillation who was referred to an outpatient gastroenterology clinic for surveillance esophagogastroduodenoscopy (EGD) for BE. On medication review, he was taking amlodipine, carvedilol, albuterol, and aspirin. He smoked half a pack per day but denied significant alcohol or substance use. He was asymptomatic. On EGD, linear, peeling fragments of the superficial mucosa were found in the distal esophagus consistent with the classic features of EDS (Figure 1). A plaque of salmon-colored mucosa was also identified in the distal esophagus. Biopsies demonstrated BE and active inflammation. Outpatient treatment with a twice-daily oral proton pump inhibitor (PPI) was initiated. Three months later, repeat EGD revealed a short segment of BE and complete resolution of EDS. Discussion: EDS is a rare endoscopic finding. Clinical manifestations vary from an incidental finding to dysphagia, odynophagia, vomiting, heartburn, and abdominal pain. Although its pathogenesis is unclear, it is thought that EDS stems from conditions that cause esophageal damage, including heavy smoking, psychoactive medications, bisphosphonates, non-steroidal anti-inflammatory drugs, and cutaneous bullous disorders. We describe the first encounter of EDS in a patient with BE. In our case, it is speculated that chronic inflammation from gastroesophageal reflux disease and tobacco use caused mucosal injury, leading to the development of not only metaplastic changes but also sloughing esophagitis. This case highlights the importance of clinical recognition of EDS as its prognosis is generally favorable if treated promptly. Mucosal healing can be achieved with discontinuation of the culprit agent and PPI therapy, reducing unnecessary investigation and treatment.Figure 1.: Endoscopy showing multiple white sheets of peeling superficial mucosa with normal basal mucosa in the distal one-third of the esophagus, consistent with EDS.