Overview
Acute esophageal necrosis, or "black esophagus," is a rare but severe condition characterized by extensive circumferential necrosis of the esophageal mucosa, often presenting with upper gastrointestinal bleeding and associated with underlying comorbidities like cardiovascular disease and gastroesophageal reflux disease 1.Diagnosis
Clinical Presentation: Odynophagia, epigastric discomfort, chest pain; upper GI bleeding (hematemesis or melena) in most cases 1.
Endoscopic Findings: Circumferential black discoloration of the esophageal mucosa indicative of necrosis 12.
Imaging: Not typically required for diagnosis but may show signs of ischemia or other underlying conditions 1.
Laboratory Tests: Elevated inflammatory markers, coagulation profile abnormalities 1.Management
Supportive Care: Fluid resuscitation, blood transfusion for hemorrhage 1.
Nutritional Support: Nasogastric tube feeding or parenteral nutrition if oral intake is contraindicated 1.
Endoscopic Intervention: Possible endoscopic debridement or stenting in selected cases to manage bleeding or strictures 1.
Management of Underlying Conditions: Address cardiovascular disease and gastroesophageal reflux disease 1.Special Populations
Elderly: Increased risk due to comorbidities like severe atherosclerosis and untreated gastroesophageal reflux disease 1.
Comorbidities: Presence of cardiovascular disease significantly influences the risk and presentation 1.Key Recommendations
Prompt recognition and management of underlying comorbidities, particularly cardiovascular disease and gastroesophageal reflux disease, are crucial (Evidence: Moderate 1).
Endoscopic evaluation is essential for diagnosis and may guide further interventions (Evidence: Moderate 12).
Supportive care including fluid resuscitation and nutritional support should be initiated early (Evidence: Expert opinion 1).References
1 Ingawale S, Vallivedu P, Chauhan A, Jacob J, Haider A, Sharma P. The two-hit hypothesis in acute esophageal necrosis: black esophagus in severe atherosclerosis and untreated gastroesophageal reflux disease: a case report. Journal of medical case reports 2026. link
2 Román Fernández A, López Álvarez A, Fossati Puertas S, Areán González I, Varela García O, Viaño López PM. Black esophagus (acute esophageal necrosis) after spinal anesthesia. Revista espanola de anestesiologia y reanimacion 2014. link