• dysphagia
• intervention
• rare diseases
• speech language pathology
• speech language therapy
• syndromes
• therapeutic

• acute esophageal necrosis (aen)
• black esophagus
• esogastroduodenoscopy
• gi bleeding
• hypoperfusion

• acute esophageal necrosis
• atrial fibrillation
• black esophagus
• gurvits syndrome
• upper gastrointestinal bleed

• Acute esophageal necrosis (AEN)
• Cardiac arrest
• Case report
• Esophageal ischemia
• Resuscitation
• Upper gastrointestinal bleeding

• acute necrotizing esophagitis
• black esophagus
• diabetic keto acidosis
• hematemesis
• type 1 diabetes mellitus (t1d)

• Acute esophageal necrosis
• Black esophagus
• Duodenal ulcer perforation
• Minimally invasive esophagectomy

• black esophagus
• endoscopy
• esophageal necrosis
• hemodynamic instability

• Acute kidney injury
• Bicarbonate
• Cerebral edema
• Children
• Deep vein thrombosis
• Glasgow Coma Scale
• Immigrant background
• Type 1 diabetes

• Female
• Adolescent
• Child
• Humans
• Diabetic Ketoacidosis/diagnosis
• Diabetic Ketoacidosis/epidemiology
• Diabetic Ketoacidosis/therapy
• Diabetes Mellitus, Type 1/complications
• Diabetes Mellitus, Type 1/diagnosis
• Diabetes Mellitus, Type 1/epidemiology
• Retrospective Studies
• Prevalence
• Intensive Care Units, Pediatric

• esophageal candidiasis
• esophageal rupture
• gastro-intestinal perforation
• naso gastric tube ngt
• nutrition support
• pulmonary critical care

• Acute Esophageal Necrosis
• Coffee-ground vomitus
• Esophagoduodenoscopy
• Gastrointestinal Bleed
• Klebsiella Pneumonia

Acute esophageal mucosal lesions (AEMLs) are an underrecognized and largely unexplored disease. Endoscopic findings are similar, and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los Angeles classification grade D (RE-D). These diseases could have different pathologies and require different treatments.

To compare AEML and RE-D to confirm that the two diseases are different from each other and to clarify the clinical features of AEML.

We selected emergency endoscopic cases of upper gastrointestinal bleeding with circumferential esophageal mucosal injury and classified them into AEML and RE-D groups according to the mucosal injury’s shape on the oral side. We examined patient background, blood sampling data, comorbidities at onset, endoscopic characteristics, and outcomes in each group.

Among the emergency cases, the AEML and RE-D groups had 105 (3.1%) and 48 (1.4%) cases, respectively. Multiple variables exhibited significantly different results, indicating that these two diseases are distinct. The clinical features of AEML consisted of more comorbidities [risk ratio (RR): 3.10; 95% confidence interval (CI): 1.68–5.71; P < 0.001] and less endoscopic hemostasis compared with RE-D (RR: 0.25; 95%CI: 0.10–0.63; P < 0.001). Mortality during hospitalization was higher in the AEML group (RR: 3.43; 95%CI: 0.82–14.40; P = 0.094), and stenosis developed only in the AEML group.

AEML and RE-D were clearly distinct diseases with different clinical features. AEML may be more common than assumed, and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding with comorbidities.

• Acute esophageal mucosal lesion
• Comorbidities
• Esophageal reflux
• Black esophagus
• Acute necrotizing esophagitis

• Acute esophageal necrosis
• Black esophagus
• Esophageal necrosis
• Gastric volvulus

• Gurvits syndrome
• acute esophageal necrosis
• black esophagus
• endoscopy

• COVID-19
• autopsy
• esophageal necrosis

• DKA
• ESRD
• black esophagus
• upper GI bleeding

• Female
• Humans
• Middle Aged
• Diabetic Ketoacidosis/complications
• Diabetic Ketoacidosis/diagnosis
• Acute Disease
• Necrosis/complications
• Esophageal Diseases/etiology
• Esophageal Diseases/complications
• Gastrointestinal Hemorrhage/etiology
• Diabetes Mellitus

• Inpatients
• Mortality
• Rebleeding
• Risk factor
• Upper gastrointestinal bleeding

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; HCO₃, 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.

Acute esophageal necrosis (AEN) is a rare clinical finding due to multifocal factors consisting of an ischemic insult to the esophagus, corrosive injury from gastric content, and diminished mucosal defense. It is also referred to as “black esophagus” or acute necrotizing esophagitis. The clinical presentation mainly consists of upper gastrointestinal bleed and abdominal pain. Associated symptoms include nausea, vomiting, and dysphagia. AEN can be diagnosed by esophagogastroduodenoscopy (EGD) with findings of diffuse circumferential black pigmentation in the distal esophagus that classically extends to the gastroesophageal junction. A diagnostic biopsy is not required but recommended. Treatment of AEN is conservative management to maintain hemodynamic stability and treat coexisting medical conditions. Herein, we present the case of a 78-year-old male who initially presented with hematemesis and abdominal discomfort of five-day duration and was subsequently found to have AEN.

Acute esophageal necrosis (AEN) is a rare endoscopic finding associated with ischemic compromise of the distal esophagus. This finding can be seen in critically ill patients with COVID-19 infection. We present a case of a COVID-19-vaccinated elderly male with multiple comorbidities and active COVID-19 pneumonia admitted to the intensive care unit with septic shock and acute hypoxemic respiratory failure. The patient developed melena, and esophagogastroduodenoscopy (EGD) was performed, which showed necrosis of the lower esophagus suggestive of AEN. AEN has been associated with high mortality and should be considered when evaluating upper gastrointestinal bleed in a critically ill patient. This case describes the first report of isolated AEN in a patient fully vaccinated against COVID-19 presenting with a severe complicated COVID-19 infection.

• acute esophageal necrosis
• acute necrotizing esophagitis
• black esophagus
• gastrointestinal bleeding

Acute esophageal necrosis (AEN), commonly referred to as black esophagus, is a rare clinical condition resulting from a combination of ischemic insult and thromboembolic injury to the esophagus. It is characterized by the circumferential black appearance of the esophagus. The risk factors for the development of AEN include coronary artery disease (CAD), diabetes mellitus, hypertension, malignancy, and alcohol use disorder. The treatment is directed at correcting the underlying medical conditions, supportive measures, and gastric acid suppression.

We present the case of a 60-year-old female with multiple medical comorbidities who was detected to have a black esophagus during the evaluation of anemia.

• anemia
• black esophagus
• endoscopy
• necrotizing esophagitis
• proton pump inhibitors

• gastro-oesophageal reflux
• gastroenterology
• gastrointestinal surgery
• oesophagus

• COVID-19
• Esophagitis, Peptic
• Esophagogastric Junction
• Hernia, Hiatal/complications
• Hernia, Hiatal/diagnostic imaging
• Humans
• SARS-CoV-2
• Stomach Volvulus/complications
• Stomach Volvulus/diagnostic imaging
• Stomach Volvulus/surgery

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.

• Acute esophageal necrosis
• Gurvits syndrome
• Acute necrotizing esophagitis
• Black Esophagus
• Diabetic Ketoacidosis
• Glucagon-like peptide-1 receptor agonists

Acute esophageal necrosis (AEN) is defined as a diffused black discoloration of the esophageal mucosa involving mainly the distal part of the esophagus. It is considered a rare clinical entity with a high mortality rate. The etiology of AEN is unknown, but it has been correlated to many causes such as malignancies, infections, and hemodynamics instability. Here, we report a case of a patient developing AEN a few days after kidney transplantation. Case Presentation. A 57-year-old male was admitted electively for kidney transplantation that he received from his son. The surgery was complicated with a significant drop in blood pressure but otherwise was uneventful. The patient was showing good signs of recovery but then suffered from significant hematemesis. An urgent upper esophagogastroduodenoscopy revealed black discoloration of the esophageal mucosa in keeping with AEN. The patient was treated with proton pump inhibitors infusion and started empirically on antivirals and antifungals. The patient's condition improved in regards to the AEN; nonetheless, the complications resulted in graft loss, and the patient returned to hemodialysis.

AEN is a critical condition that mandates early intervention. Identifying high-risk populations may aid in early anticipation and diagnosis. Patients with chronic kidney disease are at risk of atherosclerosis leading to a low flow state which is exacerbated during renal transplantation surgery, especially if the procedure was complicated with a drop in blood pressure.

Acute esophageal necrosis (AEN) or “black esophagus” is a rare clinical entity caused by necrosis of distal esophageal mucosa stemming from esophageal ischemia. Possible etiologies are broad but most commonly include possible triggers of low-flow vascular states in the esophagus, including infections, broad-spectrum antibiotic use, and gastric volvulus, among others. Patients most commonly present clinically with acute onset hematemesis and melena. Here, we describe a patient who initially presented with multiple nonspecific gastrointestinal symptoms, including abdominal pain and nausea, that progressed over a 10-day period, culminating in multiple episodes of hematemesis prior to presentation. Endoscopic evaluation confirmed the diagnosis of AEN and unveiled a possible paraesophageal hernia (PEH) as the causative factor. A subsequent videofluoroscopic barium swallow was utilized to better characterize the upper gastrointestinal anatomy and confirmed the PEH as a likely etiology. Esophagogastroduodenoscopy (EGD) can often identify PEH independently, but in patients with AEN secondary to a possible, but unclear, PEH on EGD, a videofluoroscopic barium swallow is an appropriate and useful next step in confirming the diagnosis. While treatment of AEN traditionally involves fluid resuscitation, intravenous protein pump inhibitors, and total parenteral nutrition, surgical intervention is often indicated in patients who have a contributing and symptomatic PEH.

• Acute esophageal necrosis
• Black esophagus
• Hematemesis
• Paraesophageal hernia

Acute esophageal necrosis (AEN), also termed "black esophagus," is a unique and uncommon occurrence observed in severely sick patients. Other terminologies include acute necrotizing esophagitis and Gurvits syndrome. This condition is described as a darkened distal third of the esophagus observed on endoscopy and presents as an upper gastrointestinal (GI) bleed, difficulty swallowing, abdominal pain, fever, syncope, nausea, and vomiting. The etiology of AEN has been linked to several possibilities, such as excessive gastric acid reflux, hypoperfusion, and ischemia due to impaired vascular supply and hemodynamic instability. Risk factors include increased age, sex (male), heart disease, hemodynamic insufficiency, alcohol use, gastric outlet obstruction, diabetic ketoacidosis (DKA), malnutrition, renal disease, and trauma which also have the propensity to complicate disease course. An esophageal biopsy is not warranted. Treatment of AEN is comprised of supportive management with intravenous fluids, proton pump inhibitors (PPI), sucralfate, parenteral nutrition, and antacids. Management of preexisting comorbidities associated with AEN is crucial to prevent exacerbation of the disease course that could result in a poor prognosis and increased mortality rates. This literature review article comprises epidemiology, etiology, pathogenesis, diagnosis, and management of AEN.

• acute esophageal necrosis (aen)
• black esophagus
• clinical manifestations
• diabetic ketoacidosis
• diagnosis
• endoscopy
• epidemiology
• gurvits syndrome
• risk factors
• treatment

• GI bleeding
• endoscopy

Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival.

• alcohol-induced injury
• endoscopy
• erosive oesophagitis
• gastro-oesophageal reflux disease
• oesophageal lesions

• acute oesophageal necrosis
• black spots
• forensic pathology
• gastric mucosa

Acute esophageal necrosis (AEN), also known as “black esophagus,” is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient’s underlying illness. In this article we present three cases of patients with AEN.

• Acute esophageal necrosis
• Black esophagus
• Endoscopy Gastrointestinal
• Ischemia
• Upper gastrointestinal hemorrhage

Acute esophageal necrosis (AEN) is a rare presentation of severe esophageal injury. The optimal long‐term management of complications related to AEN, particularly stricture formation, are not well defined. We report a case of AEN in a patient who presented with diabetic ketoacidosis (DKA) and had dysphagia due to refractory stricture formation after mucosal healing occurred. A 62‐year‐old male with diabetes mellitus presented with altered mental status. He was admitted for hypovolemic shock secondary to DKA and treated with vasopressors, fluid resuscitation, and insulin. After resolution of DKA, he reported persistent dysphagia. Upper endoscopy showed circumferential black mucosal discoloration throughout the entire esophagus that spared the gastroesophageal junction. He was diagnosed with AEN and was continued on a proton pump inhibitor and sucralfate with improvement in symptoms. Repeat endoscopy 4 weeks later showed a 10‐cm benign‐appearing stricture in the mid esophagus. He underwent dilation with temporary symptomatic relief; however, recurrence in symptoms has thus far necessitated a total of 10 repeat upper endoscopies, including repeat dilations along with local steroid injection therapy. AEN is a rare presentation of severe esophageal injury and is typically associated with severe hemodynamic compromise. Although most cases resolve with supportive care and mucosal healing, there is little information regarding prognosis and optimal management of complications, such as refractory esophageal strictures. We describe a case of AEN complicated by refractory symptomatic esophageal stricture despite several dilations and intralesional steroid injections and discuss our approach to treatment.

• acute esophageal necrosis
• black esophagus
• hematemesis
• kidney transplantation

• Diagnosis, Differential
• Esophagoscopy
• Esophagus/pathology
• Humans
• Kidney Failure, Chronic/surgery
• Kidney Transplantation
• Male
• Middle Aged
• Necrosis/diagnosis
• Postoperative Complications/diagnosis

• Acute esophageal necrosis
• Black esophagus
• Bypass operation
• Esophagectomy
• Indocyanine green fluorescence imaging

Patient: Female, 80-year-old

Final Diagnosis: Acute esophageal necrosis • acute pharyngitis • duodenal ulcerations • gastric erosions • gastritis

Symptoms: Dysphagia • emesis • globus • hoarseness • sore throat

Medication:—

Clinical Procedure: Esophagogastroduodenoscopy

Specialty: Gastroenterology and Hepatology

Acute esophageal necrosis (AEN), black esophagus, or Gurvits syndrome is a rare clinical disorder characterized by a striking endoscopic appearance of necrotic esophageal mucosa, universally affecting the distal esophagus and ending abruptly at the gastroesophageal junction. It has been gaining traction as a demonstrable cause of upper gastrointestinal bleeding in the 21st century. Its pathophysiology is multifactorial affecting men and the elderly disproportionally, with a mortality rate nearing 36%. AEN has been associated with numerous conditions in the past, and we aim to present an unusual case of AEN on the setting of chronic alcohol use.

• Acute esophageal necrosis
• Black esophagus
• Gurvits syndrome
• Necrotizing esophagitis