Acute Esophageal Necrosis: A View in the Dark

Abstract

Acute esophageal necrosis (AEN), also known as Gurvits syndrome, black esophagus, or acute necrotizing esophagitis, is a rare clinical entity and an unusual reason for upper gastrointestinal bleeding. It is typically described in critically ill patients with multiple medical conditions, arising from a combination of ischemic insult to the esophageal mucosa due to low-flow vascular states, corrosive injury caused by reflux of acid and pepsin, and decreased function of the mucosal barrier systems and reparative mechanisms as occurs in malnourished and debilitated physical states. Patients with AEN tend to be older men, as medical comorbidities including vascular disease, diabetes, hypertension, renal insufficiency, cardiac disease, pulmonary disease, stroke, and cirrhosis may be more common. Typically, patients present with upper gastrointestinal bleeding, and hematemesis or melena is seen in up to 90% of cases. Herein we present 3 cases of AEN in critically ill patients. We also provide a review of the literature to highlight what is currently known about this relatively uncommon esophageal disease.

Keywords: Esophageal necrosis; Gastrointestinal bleeding.

Fig. 1

Esophagogastroduodenoscopy revealed a black esophagus in the distal part of the esophagus, ending abruptly at the gastroesophageal junction.

Fig. 2

Esophageal biopsy showing a necrotic esophagus with inflammatory infiltrate. H&E. Original magnification, ×100.

Fig. 3

Esophagogastroduodenoscopy showing diffuse and circumferential esophageal necrosis.

Fig. 4

Esophagogastroduodenoscopy showing extensive esophageal necrosis with mucosal flaps involving the middle and distal thirds of the esophagus, raising the possibility of full-thickness esophageal necrosis.