Moss Kasey, Mahmood Tahrin, Spaziani Robert
Department of Internal Medicine, McMaster University, Hamilton L8S 4L8, Ontario, Canada.
Division of Gastroenterology, McMaster University, Hamilton L8S 4L8, Ontario, Canada.
World J Clin Cases. 2021 Nov 6;9(31):9571-9576. doi: 10.12998/wjcc.v9.i31.9571.
Acute esophageal necrosis (AEN) is a rare condition that has been associated with low volume states, microvascular disease, gastrointestinal (GI) mucosal damage, and impaired GI motility. It has been linked in case reports with diabetic ketoacidosis (DKA) and is commonly associated with GI bleeding (GIB).
We report a case of endoscopy confirmed AEN as a complication of DKA in a 63-year-old Caucasian male without any overt GIB and a chief complaint of epigastric pain. Interestingly, there was no apparent trigger for DKA other than a newly started ketogenic diet two days prior to symptom onset. A possible potentiating factor for AEN beyond DKA is the recent start of a Glucagon-like peptide-1 receptor agonist (GLP-1 RA), though they have not been previously connected to DKA or AEN. The patient was subsequently treated with high dose proton pump inhibitors, GLP-1 RA was discontinued, and an insulin regimen was instituted. The patient's symptoms improved over the course of several weeks following discharge and repeat endoscopy showed well healing esophageal mucosa.
This report highlights AEN in the absence of overt GIB, emphasizing the importance of early consideration of EGD.
急性食管坏死（AEN）是一种罕见疾病，与低血容量状态、微血管疾病、胃肠道（GI）黏膜损伤及GI动力障碍有关。在病例报告中，它与糖尿病酮症酸中毒（DKA）相关，且常伴有胃肠道出血（GIB）。
我们报告一例经内镜检查确诊为AEN的病例，该病例为一名63岁的白种男性，无明显GIB，主要症状为上腹部疼痛，是DKA的并发症。有趣的是，除了在症状发作前两天新开始的生酮饮食外，没有明显的DKA诱因。除DKA外，AEN的一个可能的促发因素是最近开始使用胰高血糖素样肽-1受体激动剂（GLP-1 RA），尽管此前它们尚未与DKA或AEN相关联。该患者随后接受了高剂量质子泵抑制剂治疗，停用了GLP-1 RA，并制定了胰岛素治疗方案。出院后几周内患者症状改善，复查内镜显示食管黏膜愈合良好。
本报告强调了无明显GIB情况下的AEN，强调了早期考虑进行上消化道内镜检查（EGD）的重要性。
