Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa

Sloughing esophagitis is characterized by superficial necrotic squamous epithelium and endoscopic plaques or membranes. According to abstract reports SE affects older, debilitated patients on multiple medications. This study seeks to evaluate the clinical findings in patients with SE. Thirty-one patients with necrotic superficial squamous epithelium, with endoscopic white plaques or membranes, but without fungi, were compared with 34 patients having esophageal biopsies done for any purpose other than Barrett's surveillance. Sloughing esophagits patients were older than controls (56 vs 43.5 years) and were more likely to be taking five or more medications (77 vs 32%), especially central nervous system depressants (65 vs 32%) and medications associated with esophageal injury (55 vs 18%). In 69% the plaques were in the distal and/or mid-esophagus; 23% involved the entire esophagus; 8% were limited to the proximal esophagus. There was no correlation between medication history and site. Sloughing esophagitis patients were likely to be debilitated based on evidence such as being on home oxygen, in nursing homes, bedridden, hospitalized, or malnourished, having metastatic cancer, organ transplantation, and/or being immunosuppressed. Sloughing esophagitis patients were more likely to have died since the biopsy (23 vs 3%), have peptic ulcer disease (55 vs 24%), or renal insufficiency (16% vs none), but no more likely to have dysmotility disorders, irritable bowel disease, or atherosclerosis. SE patients were less likely to have gastroesophageal reflux disease (45 vs 74%). No specific cause for sloughing esophagitis was identified, but the association with multiple drugs and conditions that may lead to esophageal stasis and/or injury, suggest that this is a local, perhaps contact injury, rather than an ischemic injury. Modern Pathology (2012) 25, 767-775; doi:10.1038/modpathol.2011.204; published online 27 January 2012