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Black esophagus. (Original Article).



Abstract

Black esophagus is a rare, relatively newly described, and usually incidental finding. The differential diagnosis includes several disease states, including ischemia, which has been implicated in acute necrotizing necrotizing /nec·ro·tiz·ing/ (nek´ro-tiz?ing) causing necrosis.
Necrotizing
Causing the death of a specific area of tissue. Human bites frequently cause necrotizing infections.
 esophagitis esophagitis /esoph·a·gi·tis/ (e-sof?ah-ji´tis) inflammation of the esophagus.

chronic peptic esophagitis  reflux e.
. Several theories have been proposed to explain its etiology.

Introduction

Black esophagus is an unusual incidental finding on esophagoscopy that first came to light in 1990. (1-3) Endoscopy will detect a diffuse blackening black·en  
v. black·ened, black·en·ing, black·ens

v.tr.
1. To make black.

2. To sully or defame: a scandal that blackened the mayor's name.

3.
 of the esophagus that ends abruptly at the transitional line of the esophagogastric junction (figure).

The differential diagnosis of black esophagus includes ischemic necrosis of the esophagus, exogenous and endogenous pigmentation, and hypersensitivity-related mucosal reactions. Coal dust deposition (4) and mucosal tattooing of the esophagus following the administration of activated charcoal (5) have also been reported. Increased melanogenesis (melanosis melanosis /mel·a·no·sis/ (mel?ah-no´sis) melanism; disordered production of melanin, with darkening of the skin.

melanosis co´li
 esophagi) may be another cause that appears to be related to chronic esophagitis. (6) Malignant melanoma, a rare occurrence in the esophagus, should be considered in the differential diagnosis. (7) Infections that can cause blackening of the esophageal mucosa include Canadida (8) and herpes (9) infections. Finally, acanthosis nigricans can manifest in this way, usually in association with gastric adenocarcinoma. (10) Ischemia appears to be implicated as the primary etiology in acute necrotizing esophagitis. (1,11)

Necrotizing esophagitis

Underlying conditions that are believed to predispose patients to an ischemic Ischemic
An inadequate supply of blood to a part of the body, caused by partial or total blockage of an artery.

Mentioned in: Antiangiogenic Therapy, Subarachnoid Hemorrhage, Ventricular Fibrillation


ischemic
 black esophagus include coronary and peripheral vascular diseases, low flow states (e.g., shock), gastric volvulus, gastric-outlet obstruction, pancreatitis, cancer, acute fatty liver of pregnancy acute fatty liver of pregnancy Fatty liver of pregnancy, see there , overwhelming infection, severe hypothermia, severe emesis emesis /em·e·sis/ (em´e-sis) vomiting.

em·e·sis
n. pl. em·e·ses
The act or process of vomiting.


Emesis
The medical term for vomiting.
, herpes infection, nasogastric-tube trauma, and hyperglycemia hyperglycemia: see diabetes.  (particularly in diabetic ketoacidosis). (12) Moreover, a hypersensitivity reaction to antibiotic therapy has been proposed as a possible cause of acute necrotizing esophagitis manifesting as black esophagus. (13)

Esophageal necrosis has also been reported to occur in Stevens-Johnson syndrome. (14) Alendronate alendronate /alen·dro·nate/ (ah-len´dro-nat) a bisphosphonate calcium-regulating agent used in the form of the sodium salt to inhibit the resorption of bone in the treatment of osteitis deformans, osteoporosis, and hypercalcemia related  use by osteoporotic patients has been associated with a severe erosive e·ro·sive
adj.
Causing erosion.
 esophagitis. (15) Finally, ingestion of strong alkaline substances (e.g., lye) can also cause a dark discoloration of the esophageal mucosa following coagulative necrosis.

A biopsy is required to help establish a diagnosis. Tissue in these cases must be obtained with caution because necrosis might extend deep into the muscular layers, which can increase the risk of iatrogenic iatrogenic /iat·ro·gen·ic/ (i-a´tro-jen´ik) resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon.  perforation.

References

(1.) Goldenberg SP, Wain SL, Marignani P. Acute necrotizing esophagitis. Gastroenterology 1990;98:493-6.

(2.) Geller A, Aguilar H, Burgart L, Gostout CJ. The black esophagus. Am J Gastroenterol 1995;90:2210-12.

(3.) Katsinelos P, Christodoulou K, Pilpilidis I, et al. Black esophagus: An unusual finding during routine endoscopy. Endoscopy 2001;33:904.

(4.) Khan HA. Coal dust deposition--rare cause of "black esophagus" [letter]. Am J Gastroenterol 1996;91:2256.

(5.) Lopes de Freitas JM, Ferreira MG, Brito MJ. Charcoal deposits in the esophageal and gastric mucosa. Am J Gastroenterol 1997;92:1359-60.

(6.) Sharma SS, Venkateswaran S, Chacko A, Mathan M. Melanosis of the esophagus. An endoscopic, histochemical, and ultrastructural study. Gastroenterology 1991;100:13-16.

(7.) Takubo K, Kanda Y, Ishii M, et al. Primary malignant melanoma of the esophagus. Hum Pathol 1983:14:727-30.

(8.) Wilcox CM, Schwartz DA. Endoscopic-pathologic correlates of Candida esophagitis in acquired immunodeficiency syndrome acquired immunodeficiency syndrome, see AIDS. . Dig Dis Sci 1996;41:1337-45.

(9.) Cattan P, Cuilerier E, Cellier C, et al. Black esophagus associated with herpes esophagitis. Gastrointest Endosc 1999;49:105-7.

(10.) Kozlowski LM, Nigra TP. Esophageal acanthosis nigricans in association with adenocarcinoma from an unknown primary site. J Am Acad Dermatol 1992;26(Pt 2):348-51.

(11.) Haviv YS, Reinus C, Zimmerman J. "Black esophagus": A rare complication of shock. Am J Gastroenterol 1996;91:2432-4.

(12.) De Langle C, Cadiot G, Calvat S, et al. [Two cases of "black esophagus" discovered during severe diabetic ketoacidosis]. Gastroenterol Clin Biol 1994:18:176-7.

(13.) Mangan TF, Colley AT, Wytock DH. Antibiotic-associated acute necrotizing esophagitis [letter]. Gastroenterology 1990;99:900.

(14.) Mahe A, Keita S, Blanc L, Bobin P. Esophageal necrosis in the Stevens-Johnson syndrome. J Am Acad Dermatol 1993:29:103-4.

(15.) Abraham SC, Cruz-Correa M, Lee LA, et al. Alendronate-associated esophageal injury: Pathologic and endoscopic features, Mod Pathol 1999;12:1152-7.

(16.) Poelman JR, Hausman RH, Hoitsma HF. Endoscopy in lye burns of oesophagus and stomach. Endoscopy 1977;9:172-7.

(17.) Howell JM. Alkaline ingestions. Ann Emerg Med 1986;15:820-5.

From the Department of Pathology (Dr. Pantanowitz and Dr. Nasser) and the Department of Gastroenterology (Dr. Gelrud), Beth Israel Deaconess Medical Center Both an international and regional referral center, Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts is a major teaching hospital of Harvard Medical School. It was formed out of the 1996 merger of Beth Israel Hospital (founded in 1916) and , Harvard Medical School Harvard Medical School (HMS) is one of the graduate schools of Harvard University. It is a prestigious American medical school located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts. , Boston.

Reprint requests: Liron Pantanowitz, MD, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215. Phone: (617) 667-4344; fax:(617)667-7120; e-mail: lpantanowitz@hotmail.com
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Author:Nasser, Imad
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Jun 1, 2003
Words:752
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