Esophagitis dissecans superficialis : a case series of 7 patients and review of the literature.

INTRODUCTION : Esophagitis dissecans superficialis (EDS) is a rare desquamative disorder of the eso-phagus, characterized by sloughing of the superficial mucosa. It is a benign entity of uncertain etiology. Most cases of EDS are idiopathic but can be caused by medications, hot beverages, chemical irritants, celiac disease and many skin conditions.

AIM AND METHODS: Knowing that few case series have described this entity, we decided to review all the cases diagnosed in our center to characterize them. The pathological institutional database of Erasme University Hospital (Brussels, Belgium) was searched for the diagnosis of EDS. We reviewed retrospectively the clinical and endoscopic findings as well as histological features of all cases of EDS (Table 1). During this period of time, 21497 upper gastrointestinal endoscopies have been performed in our institution.

RESULTS: From January 2010 to September 2016, we identified 7 cases of EDS diagnosed in our institution in this time period. During the same period, 21497 upper gastrointestinal endoscopies were performed (incidence 0.03%). Endoscopic findings evoked in 2 patients a suspicion of an esophageal tumor; the first one was described as a raised detached lesion of the distal third of the esophagus with suspicion of squamous cell carcinoma (Fig. 1) and the second as a suspected tumor of the proximal third of the esophagus (Fig. 2). For other patients, EDS was misdiagnosed as unspecific esophagitis in 2, reflux or mycotic esophagitis in 2. Only one patient was suspected to have sloughing esophagitis.Histologic features present in all of those cases were characterized by the presence of a sloughing and necrosis of the superficial layer of the esophageal squamous epithelium with negative anti HSV and anti CMV antibodies, negative periodic acid Schiff stain for fungal infections as well as absence of signs of dysplasia or signs of malignancy. In 2 patients, there was a presence of multiple bacterial colonies on the superficial epithelium. Acute inflammation was reported in 4 of the patients with the presence of eosinophils in the superficial epithelium described in 2 of these patients and of polymorphonuclear leukocytes in 2 other patients (Fig. 3).An endoscopic follow up 2 months after PPI treatment performed in 3 patients, 2 of them had an atypical endoscopic presentation with suspicion of a tumor on endoscopic examination showed a complete resolution of the esophageal lesions was observed in these patients.

CONCLUSION: EDS is a rare benign entity that endoscopists must be aware of in order not to mistake it for other entities such as esophagitis or squamous cell carcinoma. The diagnosis is based on biopsies. The prognosis is good after stopping the causative agent.