E0188 - Black Esophagus in the Setting of Diabetic Ketoacidosis: A Systematic Review of Clinical Presentation and Outcome

Mohd Elmugtaba Ibrahim, MD¹, Sneha Adidam, MD¹, Abdullahi Musa, MD², Suryanarayana Reddy Challa, MD¹, Farshad Aduli, MD¹, Angesom Kibreab, MD^3
1Howard University Hospital, Washington, DC; ²Howard University Hospital, Arlington, VA; ³Howard University, Washington, DC

Introduction: Black esophagus (BE) also known as the acute black esophagus or necrotizing esophagitis is a rare condition (0.2% in autopsy series). It is defined as a circumferential black appearing esophageal mucosa.



It arises in a setting of tissue hypoperfusion due to hemodynamic instability, insults to the esophagus with gastric acid reflux further damaging the vulnerable mucosa. Patients are often critically ill or with significant comorbidities. Septic shock or acutely decompensated heart failure can lead to hypoperfusion states that predispose patients to necrotizing esophagitis. Diabetes mellitus (DM) leads to significant microvascular disease that can be a substrate for the development of esophageal necrosis.



In this systematic review, we looked at the clinical presentation, radiological, endoscopic findings, and the outcome of the BE occurring in the setting of diabetic ketoacidosis (DKA).

Methods: A database search was conducted (PubMed, Embase, and Cochrane) for all case reports and case series of BE with DKA published in the English language. All the available reported cases were analyzed.

Results: A total of 29 patients were identified and 26 published cases were included in the analysis. The mean age of presentation was 51 years, and 74% of cases were male. DM type II 61%, DM type I in 30%, all cases included had DKA at presentation.



The most common gastrointestinal symptoms prior to endoscopic evaluation were hematemesis (60%), nausea and vomiting (15.3%), dysphagia (15.3%), and melena (3.8%) (Table 1).



34% of cases had pre-endoscopic CT chest and abdomen, 90% (8 cases) revealed esophageal thickening, and one patient CT had no findings.



On upper endoscopy, (46.1%) had pan-esophageal involvement, (34.5.62%) mid to lower esophageal involvement, (15.38%) had lower esophageal involvement, and upper esophageal involvement in 1 patient (3.85%) (table2). 42 % (11 patients) had esophageal biopsies of which (54.5%) showed acute esophageal necrosis (AEN), (and 45.4%) reported AEN with candida.



Regarding outcomes, 57% (15 patients) had repeat endoscopy which showed complete healing in 46.67%, improvement in 26.67%, No changes seen in 6.67%, and stricture as a complication was seen in 20% of the cases on repeat endoscopy Case Mortality was only 1 patient (3.7%).

Discussion: BE in the setting of DKA is rare. Clinicians should be familiar with this condition as treatment depends on addressing underlying medical problems to avoid complications and mortality.



Disclosures:


Mohd Elmugtaba Ibrahim, MD¹, Sneha Adidam, MD¹, Abdullahi Musa, MD², Suryanarayana Reddy Challa, MD¹, Farshad Aduli, MD¹, Angesom Kibreab, MD³. E0188 - Black Esophagus in the Setting of Diabetic Ketoacidosis: A Systematic Review of Clinical Presentation and Outcome, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.