Clinical and endoscopic characteristics of acute esophageal necrosis and severe reflux esophagitis. Issue 44 (5th November 2021)

• Record Type: Journal Article
• Authors: Okamoto, Takeshi; Suzuki, Hidekazu; Fukuda, Katsuyuki
• Other Names: Žarko. Babić section editor.
• Is Part Of: Medicine. Volume 100:Issue 44(2021)
• Publication Date: 2021-11-05
• Subjects: acute esophageal necrosis -- endoscopy -- gastroesophageal reflux disease -- reflux esophagitis -- upper gastrointestinal bleeding; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000027672
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Abstract: The similarities and differences between acute esophageal necrosis and severe reflux esophagitis have not been elucidated. We compared Los Angeles classification Grade C reflux esophagitis, Grade D reflux esophagitis, and acute esophageal necrosis to consider the similarities and differences between acute esophageal necrosis and severe reflux esophagitis. We retrospectively reviewed records of patients who underwent esophagogastroduodenoscopy at a tertiary referral center from January 2012 to December 2019. Data on patients diagnosed as Grade C reflux, Grade D reflux, or acute esophageal necrosis for the first time were extracted for analysis. A total of 213 patients were enrolled in the study, composed of 130 Grade C reflux, 74 Grade D reflux, and 9 acute esophageal necrosis patients. Compared to Grade C reflux patients, Grade D reflux and acute esophageal necrosis patients were more likely to be transfused ( P = .013 and P = .011, respectively), to have duodenal ulcers ( P = .025 and P = .049, respectively), and to have psychiatric illnesses ( P = .022 and P = .018, respectively). Compared to both Grade C and D reflux, acute esophageal necrosis patients were more likely to present with shock ( P = .003 and P < .001, respectively), have type 1 diabetes ( P = .030 and P = .004, respectively), and present in winter ( P < .001 and P < .001, respectively). Significant step-wise differences (Grade C < Grade D < acute esophageal necrosis) were observed in the need for admission ( P < .001 and P = .009), coffee ground emesis ( P < .001 and P = .022), and stigmata of hemorrhage on endoscopy ( P = .002 and P < .001). Admission ( P = .003) and coffee ground emesis ( P = .003) independently predicted either Grade D reflux or acute esophageal necrosis over Grade C reflux on multivariate analysis. Shock, type 1 diabetes, and winter may predict acute esophageal necrosis, while the need for admission and coffee ground emesis may predict Grade D reflux or acute esophageal necrosis.