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August 2015 Case of the Month

84 year-old man with dysphagia undergoing upper endoscopy.  Per endoscopy report, "esophageal mucosa easily sloughs off".

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The esophageal biopsy shows a striking demarcation between a brightly eosinophilic superficial parakeratotic layer and the underlying more normal appearing squamous mucosa.  The parakeratotic layer is partly sloughed in some fragments.  In addition, frequent detached squamous keratin flakes and necrotic/mummified mucosal fragments are present in the background.  Frequent bacterial colonies are associated with the sloughed mucosa.  Importantly, there is no evidence of viral inclusions, eosinophilic esophagitis, significant active inflammation, and a PAS stain is negative for fungal organisms.  These features and the clinical endoscopic description of sloughing mucosa are consistent with esophagitis dissecans superficialis (EDS).  While not entirely understood, EDS has been associated with chronic debilitation, thermal and chemical (pill) injury (NSAIDs, CNS depressants, bisphosphonates), heavy smoking, and trauma.  Most cases resolve spontaneously without lasting esophageal pathology.

August 2015 Case of the Month

   Answer: Esophagitis Dissecans Superficialis ("Sloughing Esophagitis")

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