Thanmai Kaleru, MD, Ningxin Zeng, MD, PhD Trios Health Southridge Hospital, Kennewick, WA
Introduction: Esophagitis dissecans superficialis (EDS) is a rare, incidental endoscopic finding. The etiology, management and clinical course were not well studied. We present two cases with evidence of complete resolution of esophageal sloughing with oral pantoprazole in four weeks.
Case Description/Methods: Case – 1: A 75-year-old male was referred for Esophagogastroduodenoscopy (EGD) for dysphagia, acute on chronic anemia with melena. Atypical long, linear sloughing epithelium with normal underlying mucosa in the esophagus consistent with EDS was found and confirmed by pathology. The patient was back for follow up of gastric ulcer healing after four weeks of pantoprazole 40mg once daily showed significant improvement in the appearance of the esophagus with no evidence of further sloughing or inflammation of the mucosa. Patient's dysphagia resolved completely.
Case – 2: A 67-year-old male presented with abdominal pain and EGD showed duodenal stricture requiring stenting. It also showed incidental EDS. Patient started on oral proton pump inhibitors (PPIs). Follow up EGD after four weeks showed resolution of EDS.
Discussion: EDS is typically diagnosed by EGD findings of peeling of white, vertical strips of esophageal epithelium > 2 cm long with normal underlying mucosa with lack of ulcerations or friability of adjacent mucosa. Splitting of the squamous epithelium at different levels with basal cell hyperplasia variably sized cysts/bullae, and a thick layer of parakeratosis with focal or minimal inflammation are seen on biopsy.
However, current literature mentions that acid suppression with PPI and discontinuation of triggering agents or steroids if autoimmune etiology suspected, may result in clinical improvement. We present two cases with clinical and endoscopic resolution after treatment with oral pantoprazole for four weeks, which correlated with complete resolution of clinical symptoms such as dysphagia. More clinical case-control studies with PPIs in patients with EDS may benefit to form a standard EDS management.
Figure: Endoscopy findings before and after proton pump inhibitor therapy. Pathology findings consistent with Esophagitis Dissecans Superficialis
Disclosures:
Thanmai Kaleru indicated no relevant financial relationships.
Ningxin Zeng indicated no relevant financial relationships.
Thanmai Kaleru, MD, Ningxin Zeng, MD, PhD. P3357 - Resolution of Esophagitis Dissecans Superficialis by a Short Course of PPI – Two Case Reports With Literature Review, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
