Acute necrotizing esophagitis: role of nonsteroidal anti-inflammatory drugs

Acute necrotizing esophagitis (ANE) is a rarely described entity that is thought to be a cause of upper gastrointestinal (UGI) bleeding, The present study examined the incidence of ANE among patients with UGI bleeding, as well as the clinical features of ANE, and the coexisting illnesses and medicat...

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Bibliographic Details
Published in:Journal of gastroenterology 2006-03, Vol.41 (3), p.193-197
Main Authors: Yasuda, Hiroshi, Yamada, Masaya, Endo, Yutaka, Inoue, Kazuaki, Yoshiba, Makoto
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Comorbidity
Endoscopy, Gastrointestinal
Esophagitis - complications
Esophagitis - drug therapy
Esophagitis - epidemiology
Esophagitis - pathology
Female
Gastric Mucosa - pathology
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - pathology
Humans
Incidence
Intestinal Mucosa - pathology
Japan - epidemiology
Male
Middle Aged
Necrosis
Retrospective Studies
Treatment Outcome
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Summary:Acute necrotizing esophagitis (ANE) is a rarely described entity that is thought to be a cause of upper gastrointestinal (UGI) bleeding, The present study examined the incidence of ANE among patients with UGI bleeding, as well as the clinical features of ANE, and the coexisting illnesses and medication histories of ANE patients. A retrospective analysis of clinical and endoscopic findings and the clinical course in 16 patients with ANE was carried out over a 3-year period. We observed 16 patients (6%) of ANE in 239 patients with UGI bleeding during the 3-year period. The average age of the patients was 62.5 years. The lesions predominantly affected the lower third of the esophagus, and hiatal hernia was the most common (63%) coexisting endoscopic finding. All patients had coexisting disease. Fifty percent of patients with ANE (eight patients) had taken nonsteroidal anti-inflammatory drugs (NSAIDs). ANE also occurred in four patients with diabetic ketoacidosis. Supportive therapy, including parenteral nutrition and administration of a proton pump inhibitor, was effective. ANE is more common than has been previously reported, and it should be included in the differential diagnosis of UGI bleeding. ANE could be characterized as an "acute esophageal mucosal lesion," particularly in aged patients with hiatal hernia and among those who consume NSAIDs.
ISSN:0944-1174
1435-5922
DOI:10.1007/s00535-005-1741-6