Table 1.
A summary of all 30 cases with esophagitis dissecans superficialis (EDS).
| Patient | Gender/age (year) | Race | Presentation | Diagnosis and associated condition | Endoscopic finding | Histology | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|
| 1 [8] | F/81 | Canadian | Chronic intermittent dysphagia | No significance | A thin white membrane lifting from mucosa | Mild candidal esophagitis; splitting of squamous mucosa at suprabasal and superficial layers; focal lymphocytic infiltration at deepest surfaces and diffuse parakeratosis | Double dose of PPI | Improvement |
| 2 [9] | M/51 | NA | Intermittent heartburn, anorexia, and epigastric pain without dysphagia | NSAID use | A thin white membrane lifting from mucosa with necrotic zones located on the lower esophagus | Detached superficial strips of squamous epithelium; prominent parakeratosis; acute inflammation and spongiosis in deep layers of squamous epithelium | Double dose of PPI | Endoscopic resolution 2 weeks after treatment |
| 3 [10] | F/76 | Belgian | Weight loss and nausea | COPD, CABG, hypertension | Fibrotic and sclerotic aspect of distal third of the esophagus | Sloughing of superficial layer of esophageal epithelium; presence of eosinophils on surface | No | Improvement |
| 4 [10] | F/70 | Belgian | Epigastric pain | Gastric bypass | White pseudomembranes of mid and distal third of the esophagus | Sloughing of superficial layer of esophageal epithelium; presence of PMN on surface separating it from basal layer | No | NA |
| 5 [10] | F/71 | Belgian | Epigastric pain | Arthrodesis L5-S1 | Elevated lesion of distal third of the esophagus | Sloughing of superficial layer of esophageal epithelium; presence of eosinophils on surface | No | Improvement |
| 6 [10] | F/47 | Belgian | Dysphagia | Gastrectomy with eso-jejunal anastomosis, hypothyroidism, autoimmune pancreatitis | Sloughed esophageal mucosa in the esophagus | Sloughing of superficial layer of esophageal epithelium; presence of a few bacterial colonies on surface | No | Improvement |
| 7 [10] | F/77 | Belgian | Epigastric pain | Hypertension, hypercholesterolemia, hepatitis C, OSA | Sloughing of esophageal mucosa in the distal two-third esophagus | Sloughing of superficial layer of esophageal epithelium separated from normal basal layer | No | Improvement |
| 8 [10] | M/86 | Belgian | Atypical chest pain | Hypertension, hyperuricemia | Grade A reflux esophagitis | Sloughing of superficial layer of esophageal epithelium separated from normal basal layer | No | NA |
| 9 [10] | F/83 | Belgian | Dysphagia | Hypertension hypothyroidism, Alzheimer disease, DVT | Suspicion of an esophageal tumor from 16 to 24 cm of dental arch, circumferential from 18 to 20 cm | Sloughing of superficial layer of esophageal epithelium, presence of PMN on surface separating it from basal layer | No | Improvement |
| 10 [7] | F/42 | Portuguese | Dysphagia | Type 1 diabetes mellitus, clindamycin treatment for diabetic foot | Sloughing reddish membranes in the distal esophagus, adjacent to intact easily removed mucosa | Squamous epithelium detached from underlying basal layer; preservation of remaining layers; mild parakeratosis; severe acute inflammation with some eosinophils | Double dose of PPI | Improvement |
| 11 [5] | F/59 | USA | Dysphagia and odynophagia | Hypersensitivity pneumonitis, bisphosphonate | Sloughing whitish membranes that were easily removed, adjacent to intact healthy mucosa | Parakeratosis and desquamation of epithelial layer | Bisphosphonate discontinuation | Improvement |
| 12 [4] | M/46 | Caucasian | Nausea, vomiting, regurgitation | Hypertension, NSAID use | Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, and vertical fissures | Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing | Double dose of PPI; NSAID discontinuation | Improvement |
| 13 [4] | F/42 | Caucasian | Dysphagia, regurgitation | GERD | Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, and vertical fissures | Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing | Single dose of PPI | Improvement |
| 14 [4] | F/79 | African American | Dysphagia, nausea, vomiting | GERD, bullous pemphigoid, diabetes | Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, and vertical fissures | Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing | Single dose of PPI | Improvement |
| 15 [4] | F/46 | African American | Dysphagia, dyspepsia | GERD, hypertension, diabetes | Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, vertical fissures | Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing | Double dose of PPI | Improvement |
| 16 [4] | F/55 | Hispanic | Heartburn | GERD, hypertension, NSAID use | Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, and vertical fissures | Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing | Single dose of PPI; NSAID discontinuation | Improvement |
| 17 [1] | M/61 | White | Dysphagia | NA | Diffuse erythema, patches of peeling mucosa in the mid to distal esophagus | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | Improvement |
| 18 [1] | M/81 | African American | UGIB | NA | Multiple patches of peeling mucosa | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | Improvement |
| 19 [1] | M/77 | African American | Weight loss | NA | Distal 2 cm patch of peeling mucosa | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | NA |
| 20 [1] | M/65 | White | Dysphagia | NA | Grade 4 esophagitis | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | Improvement |
| 21 [1] | M/60 | African American | UGIB | NA | Grade 3 esophagitis from the mid to distal esophagus | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | Improvement |
| 22 [1] | M/57 | African American | Epigastric pain | NA | Distal multiple patches of peeling mucosa | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | NA |
| 23 [1] | F/49 | White | Heartburn | NA | Mid to distal grade 3 esophagitis, achalasia | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | Improvement |
| 24 [1] | M/65 | White | Anemia | NA | Mid to distal grade 4 esophagitis | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | NA |
| 25 [1] | M/80 | White | Iron deficiency anemia | NA | Mid to distal grade 4 esophagitis | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | NA |
| 26 [1] | M/84 | White | UGIB | NA | Sloughing of entire esophagus | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | NA |
| 27 [1] | M/63 | White | Dysphagia | NA | Multiple patches of peeling mucosa in the mid to distal esophagus | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | NA |
| 28 [1] | M/84 | White | Weight loss | NA | Distal adherent yellow patches of peeling mucosa | Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer | Double dose of PPI | NA |
| 29 [11] | F/88 | USA | UGIB | Atrial fibrillation, mitral regurgitation, post-cardiac arrest syndrome | White, linear, desquamating plaques in the distal esophagus | Sloughing of superficial layer of esophageal epithelium; presence of eosinophils on surface; parakeratosis | No | Improvement |
| 30 (our case) | M/50 | Thai | Dysphagia | HIV infection, myasthenia gravis | Circumferential white exudates with focal areas of erosions at the lower one-third esophagus without luminal stenosis or obstruction | Foci of splitting of the squamous epithelium with few intraepithelial cystic degeneration; no parakeratosis; no basal cell hyperplasia; mild acute and chronic inflammatory infiltrates with focal squamous cell hyperplasia; and normal underlying mucosa | Double dose of PPI | Improvement |
COPD: chronic obstructive pulmonary disease; CABG: coronary artery bypass graft; OSA: obstructive sleep apnea; DVT: deep vein thrombosis; UGIB: upper gastrointestinal bleeding; PMN: polymorphonuclear cell; PPI: proton-pump inhibitor; NSAID: nonsteroidal anti-inflammatory drug.