Department of Gastroenterology and Hepatology, Nagahama City Hospital, 313 Oinuicho, Nagahama, 526-8580, Shiga, Japan.
BMC Gastroenterol. 2022 Jun 2;22(1):277. doi: 10.1186/s12876-022-02349-z.
Acute esophageal necrosis (AEN), commonly referred to as Gurvits syndrome or "black esophagus", is a rare clinical disease. We present a case of AEN associated with diabetic ketoacidosis (DKA).
A 66-year-old male came to our hospital with coffee-ground emesis, dyspnea, and general malaise. He was treated for type 2 diabetes mellitus using insulin and had not been taking his medication, including insulin, for several days. Laboratory analysis revealed severe hyperglycemia (730 mg/dL), normocytic anemia (hemoglobin level, 7.7 g/dL; mean corpuscular volume, 100.4 fL), high serum potassium (7.6 mEq/L), and a high level of blood urea (98.7 mg/dL). Ketones and glucose were detected in the urine, and serum β-hydroxybutyrate was elevated (2132 µmol/L). Arterial blood gas analysis confirmed metabolic acidosis (pH, 7.29; HCO, 10.5 mmol/L). Collectively, the patient was diagnosed with DKA and upper gastrointestinal bleeding. The patient's condition improved with intravenous fluids, and he received intravenous insulin to treat DKA. According to these findings, the patient was diagnosed with DKA and upper gastrointestinal bleeding. The patient underwent esophagogastroduodenoscopy (EGD) which revealed a circumferential necrosis of the middle and distal esophagus, immediately proximal to the gastroesophageal junction. The patient was then treated with an intravenous proton pump inhibitor. The patient continued to improve with conservative treatment and was subsequently discharged in a stable condition. An EGD repeated 14 days after discharge showed complete healing of the necrotic-like mucosal change without stricture formation of the esophagus.
AEN is rare but potentially life-threatening case of upper gastrointestinal bleeding. Therefore, a clinician should be aware of AEN as a potential cause of upper gastrointestinal bleeding in elderly patients with poorly controlled diabetes and significant comorbidities.
急性食管坏死（AEN），通常被称为 Gurvits 综合征或“黑食管”，是一种罕见的临床疾病。我们报告了一例与糖尿病酮症酸中毒（DKA）相关的 AEN 病例。
一名 66 岁男性因呕咖啡样物、呼吸困难和全身不适来我院就诊。他因 2 型糖尿病接受胰岛素治疗，但已经几天没有服用包括胰岛素在内的药物。实验室分析显示严重高血糖（730mg/dL）、正细胞性贫血（血红蛋白水平 7.7g/dL，平均红细胞体积 100.4fL）、血清钾高（7.6mEq/L）和血尿素高（98.7mg/dL）。尿中检测到酮体和葡萄糖，血清β-羟丁酸升高（2132μmol/L）。动脉血气分析证实代谢性酸中毒（pH7.29，HCO310.5mmol/L）。综合考虑，患者被诊断为 DKA 和上消化道出血。患者经静脉补液和静脉注射胰岛素治疗 DKA 后病情改善。根据这些发现，患者被诊断为 DKA 和上消化道出血。患者接受了食管胃十二指肠镜检查（EGD），发现食管中段和下段环绕性坏死，紧邻胃食管交界处近端。随后，患者接受了静脉质子泵抑制剂治疗。患者继续保守治疗，情况稳定后出院。出院后 14 天再次进行 EGD 检查显示，坏死样黏膜变化完全愈合，无食管狭窄形成。
AEN 是一种罕见但潜在危及生命的上消化道出血病例。因此，临床医生应意识到 AEN 是老年、糖尿病控制不佳且合并症显著的患者发生上消化道出血的潜在原因。
