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Surgical Pathology Criteria

Sloughing Esophagitis


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

Diagnostic Criteria

  • Strips and patches of superficial layers of squamous mucosa
    • Frequently necrotic (mummified)
    • 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 / last update: 2/3/10, 6/2/15

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
  • Glycogenic acanthosis and simple Candida infections are not characterized by epithelial necrosis and sloughing


  • 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
  • May be related to thermal and chemical (pill) injury
    • CNS depressants, NSAIDS, bisphosphonates
  • Most are not associated with cutaneous bullous disorders
    • Some cases reported associated with bullous pemphigoid


  • 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
  • Ma C, Limketkai BN, Montgomery EA. Recently highlighted non-neoplastic pathologic entities of the upper GI tract and their clinical significance. Gastrointest Endosc. 2014 Dec;80(6):960-969. doi: 10.1016/j.gie.2014.09.009. Review. PubMed PMID: 25434655.
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