Abstract | November 18, 2023
Esophagitis Dissecans Superficialis Presenting with Dysphagia
Learning Objectives
- Consider EDS as a rare cause of dysphasia
- Identify EDS as a possible cause of white plaques found in the esophagus during endoscopy
- Treat EDS with steroids if symptoms refractory to PPIs
Introduction: Esophagitis dissecans superficialis [EDS] was first reported in 1892 (1) and is also referred to as sloughing esophagus in the literature. It is a rare condition, with only about 200 cases reported each year (2). EDS is characterized by the desquamation of the superficial esophageal mucosa with normal mucosa underneath. The most common histologic features of EDS are parakeratosis and intraepithelial splitting (3), although these findings are not specific for EDS. EDS can be asymptomatic and an incidental finding on endoscopy, but in symptomatic patients the most commonly reported symptoms are chronic dysphagia, followed by expectoration or vomiting of white casts, and lastly abdominal pain (2).Treatment for EDS depends on severity of the case, but usually involves acid suppressants such as proton pump inhibitors [PPIs] (2). Steroids should be considered in refractory cases when symptoms do not improve with PPIs (2,3). Despite the striking and concerning appearance of EDS, it appears to be a benign and self-limiting process without long term sequelae (3). We report a case in which a patient presented with chronic history of acid reflux refractory to PPI treatment and new onset dysphagia where EDS was found on endoscopy.
Case Presentation: A 46-year-old female presented with chronic reflux symptoms and an 8 week history of lower esophageal dysphagia. She was on a proton pump inhibitor for 3 years with no change in symptoms even after an increase in dosing. No weight loss or esophageal impactions. No prior cervical or neck surgery. Medical history is notable for hypothyroidism on replacement treatment and obesity with a BMI of 31. The physical examination was benign with no thyromegaly or adenopathy. Esophagogastroduodenoscopy was benign other than linear esophageal plaques in the lower esophagus with normal underlying mucosa. No bleeding or ulceration was present. Differential diagnosis included EDS, candida of the esophagus, eosinophilic esophagitis and bullous skin disease. Pathology was remarkable for parakeratosis with no eosinophils or pseudohyphae.
Final Diagnosis: Esophagitis dissecans superficialis
Management and Outcome: She was treated with fluticasone propionate 440 micrograms twice daily for 4 weeks with resolution of dysphagia symptoms.
References and Resources
- Rosenberg, B. Oesophagitis dissecans superficialis. Centralbl. Allg. Pathol. u path Anat. 1892;3(2): 753-759.
- Abhijith Menon, Shivaprasad B, Uday B Nayak. Esophagitis dissecans superficialis – a rare cause of dysphagia. International Journal of Contemporary Medicine Surgery and Radiology. 2019;4(4):D182D184.
- Hart PA, Romano RC, Moreira RK, et al. Esophagitis dissecans superficialis: clinical, endoscopic, and histologic features. Dig. Dis. Sci. 2015;60(6): 20492057
