The two-hit hypothesis in acute esophageal necrosis: black esophagus in severe atherosclerosis and untreated gastroesophageal reflux disease: a case report
Abstract
Background Acute esophageal necrosis, also known as “black esophagus,” is an uncommon but potentially life-threatening condition marked by diffuse circumferential necrosis of the esophageal mucosa. It typically presents with upper gastrointestinal bleeding, such as hematemesis or melena, in 85–90% of reported cases. Acute esophageal necrosis is often multifactorial in etiology and associated with underlying comorbidities including cardiovascular disease and esophageal mucosal injury. Owing to its rarity, atypical presentations of acute esophageal necrosis can delay diagnosis and appropriate management. This case is noteworthy for its nonclassical presentation and its support of the “two-hit” hypothesis for acute esophageal necrosis pathogenesis. Case presentation A 71-year-old African American male with a medical history of coronary artery disease and untreated gastroesophageal reflux disease presented with odynophagia, epigastric discomfort, and nonradiating chest pain. He notably denied hematemesis or melena. Esophagogastroduodenoscopy revealed extensive circumferential black discoloration of the distal esophageal mucosa consistent with necrosis, along with duodenal ulcers. Biopsy findings confirmed the diagnosis of acute esophageal necrosis along with evidence of Candida infection. The patient was treated conservatively with intravenous proton pump inhibitors (esomeprazole), oral fluconazole, and sucralfate. A repeat esophagogastroduodenoscopy performed after several…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use
- Ivth brazilian consensus conference on helicobacter pylori infection
- A pSMAD/CDX2 complex is essential for the intestinalization of epithelial metaplasia
- S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013
- Step-by-step management of refractory gastresophageal reflux disease
- Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.