Q J Med 2014; 107:685–686 doi:10.1093/qjmed/hcu006 Advance Access Publication 20 January 2014
Clinical picture A young woman with pancreatitis and odynophagia
Figure 1. Endoscopy showed linear lesions with sloughing of the superficial epithelium throughout the length of the esophagus.
symptomatically. Her discomfort was exacerbated by the presence of a nasojejunal tube that was placed for feeding. The symptoms improved with resolution of her pancreatitis and she was discharged home in stable condition. Photographs and text from: D. Golovyan and A. Mehdi, Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; M.C. Alraies, Hospital Medicine, Cleveland Clinic Foundation, 950 Euclid Avenue, Mailcode A13, Cleveland, OH, USA. email: [email protected] Conflict of interest: None declared.
References 1. Hokama A, Yamamoto Y, Taira K, Nakamura M, Kobashigawa C, Nakamoto M, et al. Esophagitis dissecans superficialis and autoimmune bullous dermatoses: a review. World J Gastrointest Endosc 2010; 2:252–6.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on March 21, 2016
A 22-year-old woman presented to the hospital with vomiting and epigastric pain. Few weeks back, she underwent laparoscopic cholecystectomy, which was complicated by mild pancreatitis. Following resolution she had gone on vacation and consumed moderate amounts of alcohol. On arrival she was hypotensive and tachycardic. Computed tomography revealed 50% necrosis of the pancreas. She required aggressive management in the intensive care unit. Nine days following admission she remained in severe epigastric pain with inability to tolerate nasojejunal nutrition. This was associated with throat pain and dysphagia. The decision was made to evaluate for the presence of an obstructing calculus in the common bile duct by endoscopy with ultrasonography. No calculus was identified, but endoscopy revealed linear lesions with sloughing of the superficial epithelium throughout the length of the esophagus (Figure 1). Correlating her clinical and endoscopic findings was consistent with esophagitis dessicans superficialis (EDS) which is a rare, benign endoscopic finding characterized by linear fissuring and desquamation of the pale superficial epithelium of the esophagus. Occasionally it can present as emesis of whole esophageal casts. Recent literature has focused on the relationship between EDS and autoimmune bullous dermatitis,1 but most cases are idiopathic or have diverse associations including bisphospanates, heavy smoking, celiac disease, esophageal sclerotherapy and critical illness. To our knowledge, this is the first case of EDS associated with acute necrotizing pancreatitis. EDS is generally a self-limiting condition as esophageal mucosa regenerates after resolution of the primary insult, but has been associated with death in severely debilitated patients.2 Proton pump inhibitors are the mainstay therapy.3 In clinical pathologic study of 12 cases of EDS, the use of proton pump inhibitor has been associated with complete resolution of the disease in four out of five patients that returned for follow-up endoscopy.3 Our patient was started on a 2-week course of a proton pump inhibitor and managed
686
Clinical picture
2. Purdy JK, Appelman HD, McKenna BJ. Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa. Mod Pathol 2012; 25:767–75.
3. Carmack S, Vemulapalli R, Spechler S, Genta R. Esophagitis dissecans superficialis (‘‘sloughing esophagitis’’): a clinicopathologic study of 12 cases. Am J Surg Pathol 2009; 33:1789–94.
Downloaded from by guest on March 21, 2016
Clinical picture A young woman with pancreatitis and odynophagia
Figure 1. Endoscopy showed linear lesions with sloughing of the superficial epithelium throughout the length of the esophagus.
symptomatically. Her discomfort was exacerbated by the presence of a nasojejunal tube that was placed for feeding. The symptoms improved with resolution of her pancreatitis and she was discharged home in stable condition. Photographs and text from: D. Golovyan and A. Mehdi, Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; M.C. Alraies, Hospital Medicine, Cleveland Clinic Foundation, 950 Euclid Avenue, Mailcode A13, Cleveland, OH, USA. email: [email protected] Conflict of interest: None declared.
References 1. Hokama A, Yamamoto Y, Taira K, Nakamura M, Kobashigawa C, Nakamoto M, et al. Esophagitis dissecans superficialis and autoimmune bullous dermatoses: a review. World J Gastrointest Endosc 2010; 2:252–6.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on March 21, 2016
A 22-year-old woman presented to the hospital with vomiting and epigastric pain. Few weeks back, she underwent laparoscopic cholecystectomy, which was complicated by mild pancreatitis. Following resolution she had gone on vacation and consumed moderate amounts of alcohol. On arrival she was hypotensive and tachycardic. Computed tomography revealed 50% necrosis of the pancreas. She required aggressive management in the intensive care unit. Nine days following admission she remained in severe epigastric pain with inability to tolerate nasojejunal nutrition. This was associated with throat pain and dysphagia. The decision was made to evaluate for the presence of an obstructing calculus in the common bile duct by endoscopy with ultrasonography. No calculus was identified, but endoscopy revealed linear lesions with sloughing of the superficial epithelium throughout the length of the esophagus (Figure 1). Correlating her clinical and endoscopic findings was consistent with esophagitis dessicans superficialis (EDS) which is a rare, benign endoscopic finding characterized by linear fissuring and desquamation of the pale superficial epithelium of the esophagus. Occasionally it can present as emesis of whole esophageal casts. Recent literature has focused on the relationship between EDS and autoimmune bullous dermatitis,1 but most cases are idiopathic or have diverse associations including bisphospanates, heavy smoking, celiac disease, esophageal sclerotherapy and critical illness. To our knowledge, this is the first case of EDS associated with acute necrotizing pancreatitis. EDS is generally a self-limiting condition as esophageal mucosa regenerates after resolution of the primary insult, but has been associated with death in severely debilitated patients.2 Proton pump inhibitors are the mainstay therapy.3 In clinical pathologic study of 12 cases of EDS, the use of proton pump inhibitor has been associated with complete resolution of the disease in four out of five patients that returned for follow-up endoscopy.3 Our patient was started on a 2-week course of a proton pump inhibitor and managed
686
Clinical picture
2. Purdy JK, Appelman HD, McKenna BJ. Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa. Mod Pathol 2012; 25:767–75.
3. Carmack S, Vemulapalli R, Spechler S, Genta R. Esophagitis dissecans superficialis (‘‘sloughing esophagitis’’): a clinicopathologic study of 12 cases. Am J Surg Pathol 2009; 33:1789–94.
Downloaded from by guest on March 21, 2016
