Department of Medicine, Unit of Internal Medicine, Ospedale del Delta, Lagosanto, Italy.
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Am J Case Rep. 2023 Aug 15;24:e939624. doi: 10.12659/AJCR.939624.
BACKGROUND Acute esophageal necrosis, or Gurvits syndrome, is a rare clinical process often secondary to a systemic low-flow state. It can be caused by several medical conditions, and it is thought to arise from a combination of impaired mucosal barrier and chemical and ischemic insults to the esophagus. Acute esophageal necrosis usually presents with severe complications due to delayed diagnosis and only rarely has surgical indications. We present a case of Gurvits syndrome, presumably triggered by metabolic acidosis in a diabetic patient. CASE REPORT A 61-year-old man with history of hypertension and type 2 diabetes mellitus treated with metformin, canagliflozin, glimepiride, and pioglitazone came to our attention with persistent vomiting, odynophagia, chest pain after each meal, and progressive weight loss. Arterial blood analysis showed mild metabolic acidosis, while the first esophagogastroduodenoscopy performed revealed a circumferential black appearance of the esophageal mucosa, as in concentric necrosis of the distal esophagus with possible fungal superinfection. Brushing cytology confirmed the infection by Candida spp. and the patient was treated with intravenous fluconazole. The second esophagogastroduodenoscopy, performed after 2 weeks, showed almost complete healing of the esophageal mucosa; in this case, biopsy confirmed mucosal ischemia and necrosis, without showing deep impairment of the mucosa by fungal agents. CONCLUSIONS Due to its high lethality, often caused by the underlying medical diseases, acute esophageal disease should be considered in the differential diagnosis of digestive symptoms, even without upper gastrointestinal bleeding. Prompt diagnosis and treatment of contextual collateral conditions can help clinicians to avoid the worst outcomes of the disease. Among the causative factors of metabolic acidosis leading to esophageal necrosis we recognized metformin and dapagliflozin.
急性食管坏死，或 Gurvits 综合征，是一种罕见的临床过程，通常继发于全身低血流状态。它可能由几种医学病症引起，被认为是由受损的黏膜屏障和化学及缺血性损伤食管的综合作用引起的。急性食管坏死通常由于诊断延迟而导致严重并发症，且很少有手术指征。我们报告了一例 Gurvits 综合征，推测是由糖尿病患者的代谢性酸中毒引起的。
一名 61 岁男性，有高血压和 2 型糖尿病病史，服用二甲双胍、卡格列净、格列美脲和吡格列酮。因持续性呕吐、吞咽困难、每次餐后胸痛和进行性体重减轻而就诊。动脉血气分析显示轻度代谢性酸中毒，而首次进行的食管胃十二指肠镜检查显示食管黏膜呈环形黑色外观，类似于远端食管同心坏死，可能伴有真菌感染。刷检细胞学检查证实为念珠菌属感染，患者接受了氟康唑静脉治疗。2 周后进行的第二次食管胃十二指肠镜检查显示食管黏膜几乎完全愈合；在这种情况下，活检证实了黏膜缺血和坏死，没有显示真菌剂对黏膜的深度损伤。
由于其高死亡率，通常由潜在的医疗疾病引起，急性食管疾病应被视为消化系统症状的鉴别诊断，即使没有上消化道出血。及时诊断和治疗相关伴随疾病可以帮助临床医生避免疾病的最坏结果。在导致食管坏死的代谢性酸中毒的致病因素中，我们认识到了二甲双胍和达格列净。
