Esophagitis Dissecans Superficialis: An Uncommon Endoscopic Finding
Abstract
Esophagitis dissecans superficialis (EDS), also known as sloughing esophagitis, is a rare and frequently underrecognized esophageal disorder characterized by superficial sloughing of the esophageal mucosa. Its variable clinical presentation and overlap with structural esophageal abnormalities may result in misdiagnosis and unnecessary diagnostic or therapeutic interventions. We report a case of a 25-year-old woman with no history of chronic degenerative, autoimmune, or atopic disease who presented with abrupt retrosternal chest pain, recurrent vomiting, progressive esophageal dysphagia, halitosis, hematemesis, and marked unintentional weight loss. Initial evaluation showed a double-lumen appearance on barium esophagography and an upper endoscopic appearance initially interpreted as a large pharyngoesophageal diverticulum. Repeat endoscopy subsequently revealed extensive longitudinal sloughing and detachment of the esophageal mucosa, supporting the diagnosis of EDS. Histopathologic evaluation demonstrated a submucosal blistering lesion infiltrated by eosinophils, without evidence of malignancy or dysplasia. These findings raised suspicion for esophageal bullous pemphigoid; however, direct immunofluorescence was unavailable, and an autoimmune bullous disorder could not be definitively confirmed. Additional computed tomography imaging showed no evidence of esophageal disruption, mediastinal collection, pneumomediastinum, malignancy, or another structural abnormality. Severe…
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