Clinical features of acute esophageal mucosal lesions and reflux esophagitis Los Angeles classification grade D: A retrospective study

Table 1 Patient background and medications, n (%)

Parameter	AEML (n = 105)		RE-D (n = 48)	Risk ratio (95%CI)	P value
	Black esophagus (n = 19)	Non-black esophagus (n = 86)
Age in yr, median (IQR)	75.0 (65.0–85.0)		87.0 (78.0–91.3)	0.34	< 0.001
	83.0 (71.5–86.0)	75.0 (65.0–84.0)
Male	61 (58.1)		13 (27.1)	2.15 (1.31–3.51)	< 0.001
	11 (57.9)	50 (58.1)
Chief complaint					0.713
Hematemesis	30 (28.3)		16 (33.3)
	6 (31.6)	24 (27.9)
Black vomiting	65 (61.0)		26 (54.2)
	10 (52.6)	54 (62.8)
Black stools	11 (10.5)		6 (12.5)
	3 (15.8)	8 (9.3)
Presence of shock vitality	29 (27.6)		8 (16.7)	1.66 (0.82–3.35)	0.16
	6 (31.6)	23 (26.7)
Underlying conditions
Hypertension	49 (46.7)		23 (47.9)	0.97 (0.68–1.39)	1
	13 (68.4)	36 (41.9)
Diabetes mellitus	23 (22.1)		4 (8.3)	2.63 (0.96–7.18)	0.043
	4 (21.1)	19 (22.4)
Chronic kidney disease	19 (18.3)		7 (14.6)	1.24 (0.56–2.75)	0.649
	5 (26.3)	14 (16.5)
Coronary artery disease	13 (12.4)		1 (2.1)	5.94 (0.8–44.14)	0.065
	3 (15.8)	10 (11.6)
Liver cirrhosis	3 (2.9)		2 (4.2)	0.69 (0.12–3.97)	0.649
	0 (0.0)	3 (3.5)
Previous malignancy	30 (28.6)		5 (10.4)	2.74 (1.13–6.63)	0.013
	7 (36.8)	23 (26.7)
Medications
NSAIDs	13 (12.4)		2 (4.2)	2.97 (0.70–12.66)	0.148
	3 (15.8)	10 (11.6)
Antithrombotic	28 (26.7)		17 (35.4)	0.75 (0.46–1.24)	0.339
	3 (15.8)	25 (29.1)
Steroids	4 (3.8)		1 (2.1)	1.83 (0.21–15.93)	1
	0 (0.0)	4 (4.7)
Antibiotics	8 (7.6)		1 (2.1)	3.66 (0.47–28.4)	0.274
	2 (10.5)	6 (7.0)
Acid blockers	42 (40.4)		15 (31.2)	1.28 (0.79–2.07)	0.368
	10 (52.6)	32 (37.6)

Age was calculated with an effect size r because the risk ratio could not be calculated. 95%CI: 95% confidence interval; AEML: Acute esophageal mucosal lesion; IQR: Interquartile range; NSAIDs: Nonsteroidal anti-inflammatory drugs; RE-D: Reflux esophagitis Los Angeles classification grade D.

Table 2 Blood sampling data

Parameter	AEML (n = 105)		RE-D (n = 48)	Effect size, r	P value
	Black esophagus (n = 19)	Non-black esophagus (n = 86)
White blood cell in μL, median (IQR)	11650 (8300–14700)		8700 (6750–10925)	0.26	< 0.001
	13100 (8750–16700)	11200 (8225–14500)
Hemoglobin in g/dL, (mean ± SD)	10.70 (3.47)		9.45 (2.81)	0.2	0.026
	10.53 (3.58)	10.78 (3.46)
Albumin in g/dL, (mean ± SD)	3.11 (0.97)		3.00 (0.74)	0.06	0.483
	2.91 (1.14)	3.15 (0.93)
BUN in mg/dL, median (IQR)	36.60 (20.50–62.40)		28.05 (16.90–37.92)	0.21	0.009
	35.10 (18.95– 67.85)	39.20 (20.65–61.90)
Creatinine in mg/dL, median (IQR)	1.10 (0.87– 2.32)		0.80 (0.63–0.94)	0.37	< 0.001
	1.34 (0.90–2.63)	1.09 (0.84–2.10)
Glucose in mg/dL, median (IQR)	141 (110–196)		124.00 (99.00–147.00)	0.20	0.015
	137 (106–172)	145 (111–203)
CRP in mg/dL, median (IQR)	1.59 (0.35–5.22)		0.45 (0.23–1.93)	0.24	0.003
	1.37 (0.31–4.68)	1.64 (0.38–5.48)
Lactate in mmol/L, median (IQR)	3.18 (1.96–5.14)		1.81 (1.38–2.38)	0.40	< 0.001
	3.45 (2.76–6.31)	3.02 (1.94–4.75)

The following blood sampling data were not measured: albumin level in one case in the acute esophageal mucosal lesion (AEML) group (1 in the non-black esophagus); glucose level in six cases in the AEML group (one and five cases of the black and non-black esophagus, respectively) and three cases in the reflux esophagitis Los Angeles classification grade D (RE-D) group; C-reactive protein level in one case in the AEML group (1 in the non-black esophagus); and lactate level in 23 cases in the AEML group (5 and 18 cases of the black and non-black esophagus, respectively) and 15 cases in the RE-D group. BUN: Blood urea nitrogen; IQR: Interquartile range; SD: Standard deviation.

Table 3 Comorbidities at onset, n (%)

	AEML (n = 105)		RE-D (n = 48)	Risk ratio (95%CI)	P value
	Black esophagus (n = 19)	Non-black esophagus (n = 86)
Comorbidities	61 (57.5)		9 (18.8)	3.10 (1.68–5.71)	< 0.001
Infection	23 (21.7)		5 (10.4)
	3 (15.8)	20 (23.0)
Treatment for malignancy	9 (8.5)		0 (0.0)
	4 (21.1)	5 (5.7)
Prerenal failure	8 (7.5)		1 (2.1)
	1 (5.3)	7 (8.0)
After surgery	7 (6.6)		1 (2.1)
	1 (5.3)	6 (6.9)
Stroke	4 (3.8)		1 (2.1)
	0 (0.0)	4 (4.6)
Alcoholic ketoacidosis	4 (3.8)		0 (0.0)
	0 (0.0)	4 (4.6)
Diabetic ketoacidosis/Hyperosmolar hyperglycemic syndrome	2 (1.9)		0 (0.0)
	1 (5.3)	1 (1.1)
Pulmonary embolism	1 (0.9)		0 (0.0)
	0 (0.0)	1 (1.1)
Peripheral arterial disease	1 (0.9)		0 (0.0)
	0 (0.0)	1 (1.1)
Duodenal ulcer	1 (0.9)		0 (0.0)
	0 (0.0)	1 (1.1)
Liver disease	1 (0.9)		0 (0.0)
	1 (5.3)	0 (0.0)
Heart failure	0 (0.0)		1 (2.1)
	0 (0.0)	0 (0.0)

AEML: Acute esophageal mucosal lesion; RE-D: Reflux esophagitis Los Angeles classification grade D; 95%CI: 95% confidence interval.

Table 4 Need for endoscopic hemostasis and endoscopic findings, n (%)

	AEML (n = 105)		RE-D (n = 48)	Risk ratio (95%CI)	P value
	Black esophagus (n = 19)	Non-black esophagus (n = 86)
Need of endoscopic hemostasis	6 (5.7)		11 (22.9)	0.25 (0.10–0.63)	0.004
	0 (0.0)	6 (7.0)
Hiatus hernia	77/103 (74.8)		46/47 (97.9)	0.76 (0.68–0.86)	< 0.001
	14/18 (77.8)	64/85 (74.4)
Gastric atrophy	39 (36.8)		15 (31.2)	1.19 (0.73–1.94)	0.586
	5 (26.3)	34 (39.1)
Gastric ulcer	31 (29.2)		1 (2.1)	14.17 (1.99–100.79)	< 0.001
	8 (42.1)	23 (26.4)
Duodenal ulcer	21 (19.8)		3 (6.2)	3.20 (1.00–10.21)	0.033
	5 (26.3)	16 (18.4)

AEML: Acute esophageal mucosal lesion; RE-D: Reflux esophagitis Los Angeles classification grade D; 95%CI: 95% confidence interval.

Hiatus hernia could not be evaluated in 2 cases in the AEML group (1 in black esophagus, 1 in non-black esophagus) and 1 case in the RE-D group.

Table 5 Outcomes in patients, n (%)

	AEML (n = 106)		RE-D (n = 48)	Risk ratio (95%CI)	P value
	Black esophagus (n = 19)	Non-black esophagus (n = 87)
Mortality during hospitalization	15 (14.2)		2 (4.2)	3.43 (0.82–14.40)	0.094
	5 (26.3)	10 (11.5)
Esophageal stenosis	4 (3.8)		0 (0.0)		0.309
	0 (0.0)	4 (4.6)

AEML: Acute esophageal mucosal lesion; RE-D: Reflux esophagitis Los Angeles classification grade D; 95%CI: 95% confidence interval.