Acute esophageal necrosis: a rare black esophagus syndrome
Abstract
Background: Acute esophageal necrosis is a rare condition characterized by diffuse black discoloration of the distal esophageal mucosa with abrupt demarcation at the gastroesophageal junction. It develops due to the combined effects of ischemia, impaired mucosal defense and chemical injury from refluxed gastric contents. The condition is typically associated with upper gastrointestinal bleeding and severe systemic comorbidities.
Aim: The aim of this review is to summarize current knowledge on acute esophageal necrosis and to highlight clinically relevant aspects of diagnosis, risk assessment and management that may support clinical decision making.
Material and Methods: A narrative literature review was performed using PubMed, Scopus, Web of Science and Google Scholar. Peer reviewed full text publications in English from 1990 to 2025 were included. Search terms comprised acute esophageal necrosis, black esophagus, ischemic esophagitis, gastrointestinal hemorrhage, endoscopic findings, management and outcomes.
Results: Acute esophageal necrosis is a rare but serious cause of upper gastrointestinal bleeding with an incidence between 0.01 percent and 0.28 percent. It predominantly affects elderly or critically ill patients with multiple comorbidities. Available data indicate a multifactorial pathogenesis involving ischemic injury, loss of mucosal integrity and chemical damage from reflux. Mortality of approximately 32 percent is mainly related to underlying systemic disease…
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