Sloughing Esophagitis

Definition

• Esophageal disorder characterized by sloughing of large patches of superficial mucosa

Diagnostic Criteria

• Strips and patches of superficial layers of squamous mucosa
  • Frequently necrotic
  • Bacterial and fungal colonies frequent
  • Usually suprabasal
• Acute and/or chronic inflammation variable or absent
  • Usually sparse
• Parakeratosis in all cases
  • Orthokeratosis is variable
• Usually visible endoscopically as strips and patches of detaching white mucosa
  • Some cases not recognized endoscopically
• Identical findings have been described in some patients with bullous pemphigoid

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting : 2/3/10

Differential Diagnosis

• Cutaneous bullous disorders should be ruled out
  • Immunofluorescence is negative for C3 and Ig
• Eosinophilic esophagitis may slough the superficial layer of mucosa with an eosinophilic infiltrate
  • Large numbers of eosinophils are not seen in sloughing esophagitis
• Artifactually induced fragments of mucosa will not generally show features such as:
  • Epithelial necrosis
  • Bacterial and fungal colonies
  • Keratosis

Clinical

• May be associated with nonspecific upper GI symptoms but frequently is asymptomatic
  • Esophageal casts have been vomited
• Wide age range
• Males and females both may be involved
• Usually resolves spontaneously and completely
• Most are not associated with cutaneous bullous disorders or drug therapy
  • Some cases reported associated with bullous pemphigoid

Bibliography

• Carmack SW, Vemulapalli R, Spechler SJ, Genta RM. Esophagitis dissecans superficialis ("sloughing esophagitis"): a clinicopathologic study of 12 cases. Am J Surg Pathol. 2009 Dec;33(12):1789-94.
• Ponsot P, Molas G, Scoazec JY, Ruszniewski P, Hénin D, Bernades P. Chronic esophagitis dissecans: an unrecognized clinicopathologic entity? Gastrointest Endosc. 1997 Jan;45(1):38-45.
• Cesar WG, Barrios MM, Maruta CW, Aoki V, Santi GG. Oesophagitis dissecans superficialis: an acute, benign phenomenon associated with pemphigus vulgaris. Clin Exp Dermatol. 2009 Dec;34(8):e614-6.