Khola Qamar, MD1, Abhinav Tiwari, MD2
1Dartmouth-Hitchcock Medical Center, Bennington, VT; 2William Beaumont Hospital, Royal Oak, MI
Introduction: Esophagitis dissecans superficialis (EDS) is a rare condition characterized classically by sloughing of the esophageal mucosa. EDS is a benign condition that usually resolves without lasting pathology. EDS can be associated with medications, chemical irritants, hot beverages, autoimmune diseases. Here we present a case of EDS which mimicked Eosinophilic esophagitis on endoscopy.
Case Description/Methods: 76 y old male with PMH of CAD on ASA presented with chief complain of dysphagia to solid food underwent EGD that revealed mucosal friability, non-obstructing Schatzki ring, faint mucosal rings. The esophagus was dilated with 18 Fr savory dilator. Biopsies from mid and distal esophagus showed nonspecific inflammation with no intramucosal eosinophils. EGD was repeated 3 months later while he was taking PPI BID. Repeat EGD showed esophagus with circumferential rings, congestions, friability and a thin white membrane lifting from the mucosa. Biopsies from mid and distal esophagus showed splitting of squamous mucosa, focal lymphocytic infiltration and diffuse parakeratosis consistent with EDS. He was continued with PPI BID with the improvement of symptoms.
Discussion: Classical EDS has been characterized by stripped, whitish mucosa with or without bleeding, vertical fissures and circumferential cracks. EDS is associated with medications such as bisphosphonates or NSAIDs, chemical irritants, celiac disease, hot beverages, autoimmune bullous dermatoses or idiopathy. Commonly presents as dysphagia, anemia, pain, and heartburn. It is unclear if 81 mg ASA taken by our patient is a culprit, as he did not have any other known risk factor. Treatment includes PPI and discontinuing precipitating factors and medications. In this case, endoscopic findings initially mimicked EoE, however, repeat EGD with biopsies revealed underlying EDS.
Citation: Khola Qamar, MD; Abhinav Tiwari, MD. P0337 - RARE CASE OF ESOPHAGITIS DISSECANS SUPERFICIALIS MIMICKING EOSINOPHILIC ESOPHAGITIS TREATED WITH PPI. Program No. P0337. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.