Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.408
Peer-review started: November 25, 2022
First decision: January 23, 2023
Revised: January 27, 2023
Accepted: March 3, 2023
Article in press: March 3, 2023
Published online: March 27, 2023
Recently, the concept of acute esophageal mucosal lesions (AEML), which encompasses both Black Esophagus and its milder variant, has been proposed, particularly in the Asian region.
The clinical manifestations of AEML remain inadequately understood and have been misdiagnosed as reflux esophagitis Los Angeles classification grade D (RE-D).
This study aimed to differentiate AEML from RE-D and to elucidate the clinical features of AEML.
We selected emergency endoscopic cases of upper gastrointestinal bleeding characterized by circumferential esophageal mucosal injury and classified them into AEML and RE-D groups based on the shape of mucosal injury observed on the oral side. We subsequently examined patient demographics, blood sampling data, comorbidities at onset, endoscopic characteristics, and outcomes in each group.
Among the emergency cases, the incidence of AEML and RE-D were 3.1% and 1.4%, respectively. A comparison of multiple variables revealed significant differences, suggesting that these two conditions are distinct. The clinical features of AEML were characterized by a higher prevalence of comorbidities [risk ratio (RR): 3.10; P < 0.001] and a lower rate of endoscopic hemostasis compared with RE-D (RR: 0.25; P < 0.001). Additionally, in-hospital mortality was higher in the AEML group (RR: 3.43; P = 0.094), and stenosis was observed exclusively in the AEML group.
AEML and RE-D were clearly distinct diseases with different clinical features. AEML may be more prevalent than previously thought, and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding accompanied by comorbidities.
In the future, we aim to conduct studies on a larger sample size across multiple institutions.