Deliwala Smit S, Bala Areeg, Haykal Tarek, Elbedawi Mamoon M, Bachuwa Ghassan, Gurvits Grigoriy E
Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA.
Department of Internal Medicine, Division of Gastroenterology, Michigan State University at Hurley Medical Center, Flint, MI, USA.
Am J Case Rep. 2020 Sep 3;21:e926019. doi: 10.12659/AJCR.926019.
BACKGROUND Acute esophageal necrosis (AEN), also known as black esophagus or Gurvits syndrome, is an infrequently seen clinical condition distinguishable by a visually striking endoscopic appearance of necrotic esophageal mucosa that involves the distal esophagus with proximal extensions ending at the gastroesophageal junction. Since its early recognition pathologically in the 1960s and endoscopically in the 1990s, AEN, despite its rarity, is being increasingly recognized as a demonstratable cause of upper gastrointestinal bleeding. Cases of pan-esophageal necrosis are sparsely reported, leaving management guidance to isolated case reports. CASE REPORT An 80-year-old female smoker with advanced chronic obstructive pulmonary disease presented with signs and symptoms of acute pharyngitis and globus sensation that had been evolving over the preceding weeks. An esophagogastroduodenoscopy revealed circumferential necrotic mucosa encircling the entire lumen of the esophagus. The patient was made nil-per-os and started on high-dose anti-reflux therapy with adequate hemodynamic resuscitation. CONCLUSIONS AEN is multifactorial but primarily a combination of decreased tissue perfusion and a massive influx of gastric contents in settings of impaired local defense barriers. Despite its dramatic presentation, the majority of cases resolve with conservative medical management, foregoing surgical interventions.
背景 急性食管坏死（AEN），也称为黑色食管或古尔维茨综合征，是一种临床少见的疾病，其特征为内镜下可见食管远端黏膜坏死，近端延伸至胃食管交界处，外观引人注目。自20世纪60年代在病理学上首次发现，90年代在内镜下得到确认以来，尽管AEN罕见，但它越来越被认为是上消化道出血的一个可证实的病因。全食管坏死的病例报道稀少，治疗指导仅来自个别病例报告。病例报告 一名80岁老年女性吸烟者，患有晚期慢性阻塞性肺疾病，出现急性咽炎症状和咽喉部异物感，持续数周。食管胃十二指肠镜检查显示食管全周黏膜坏死，环绕整个食管腔。患者禁食，并开始接受高剂量抗反流治疗及充分的血流动力学复苏。结论 AEN是多因素导致的，但主要是在局部防御屏障受损的情况下，组织灌注减少和大量胃内容物反流共同作用的结果。尽管其表现严重，但大多数病例通过保守药物治疗即可缓解，无需手术干预。
