P1423 - Atypical Histopathology in Chronic GERD

Yllen Hernandez-Blanco, MD, Zhenjian Cai, MD, PhD, Asmeen Bhatt, MD, PhD
University of Texas Health Science Center at Houston, Houston, TX

Introduction: Esophagitis Dissecans Superficialis (EDS) is an uncommon benign condition that involves desquamation of the esophageal mucosa. It has been associated with medications, autoimmune diseases, irritant exposure, and heavy smoking. Diagnostic criteria require parakeratosis on histopathology, but evidence of strips of detaching white mucosa may be seen. In this particular case, EDS had a non-specific presentation that, on endoscopy, appeared similar to reflux-related esophagitis.

Case Description/Methods: A 70-year-old woman with chronic gastroesophageal reflux disease (GERD), type II diabetes mellitus and a complex cardiac history presented with worsening nausea, vomiting, and heartburn despite once daily proton pump inhibitor (PPI) therapy. The patient denied history of smoking, drug or alcohol abuse. An upper endoscopy revealed a normal proximal esophagus, a mild whitish exudate in the mid esophagus (a) and salmon-colored mucosa (b) in the distal esophagus, findings consistent with GERD. However, biopsy specimens from distal esophagus showed a typical two-toned appearance of the squamous epithelium with superficial eosinophilic zone with parakeratosis, focal splitting/sloughing into the esophageal lumen, and a relative normal-appearing basal zone with basal cell hyperplasia (c) suggestive of EDS. No fungal elements or intestinal metaplasia were identified.

Discussion: EDS is common in the elderly population who have a history of cardiac illness and take medications such as bisphosphonates and nonsteroidal anti-inflammatory drugs. However, this case demonstrates multiple atypical features that are not usually seen in patients with EDS. Upper endoscopy did not demonstrate gross sloughing of the esophageal mucosa and the patient had few risk factors for the condition, including the absence of use of causative medications. Here, EDS was an incidental finding, not believed to be the primary cause of the patient’s pathology. Nevertheless, this case highlights the need to keep a broad differential when esophagitis is observed, since common features for EDS may not be seen. The condition is typically self-limited, but treatment involves cessation of the precipitating factor and acid suppressants. Our patient was started on a H2 receptor antagonist and a PPI, with improvement of symptoms. In summary, it is relevant to consider EDS as part of esophagitis work up due to its non-specific presentation, coexistence, and similarity to other esophageal pathologies.




Figure: Endoscopic and histopathological findings.


Disclosures:
Yllen Hernandez-Blanco indicated no relevant financial relationships.
Zhenjian Cai indicated no relevant financial relationships.
Asmeen Bhatt indicated no relevant financial relationships.


Yllen Hernandez-Blanco, MD, Zhenjian Cai, MD, PhD, Asmeen Bhatt, MD, PhD. P1423 - Atypical Histopathology in Chronic GERD, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.