Acute esophageal necrosis, commonly known as black esophagus, is a serious clinical condition that requires prompt diagnosis and management to improve morbidity and mortality. We present a 47-year-old woman who had this potentially lethal condition. The patient initially presented with hematemesis, and esophagogastroduodenoscopy at presentation showed diffuse esophageal ulcerations, erosions, and necrosis. During her admission, she required multiple blood transfusions for active bleeding, after which her clinical condition stabilized. Repeat esophagogastroduodenoscopy showed near-complete resolution of the earlier findings.

INTRODUCTION: Gastrointestinal pathologies are a common etiology of organic failure to thrive and feeding difficulties; therefore failure to thrive can be a common indication for esophagogastroduodenoscopy (EGD), especially in infants and young children. However there has been no recent studies investigating diagnostic outcome of EGD in children specifically with failure to thrive or feeding difficulties. AIM: To investigate the outcome of EGD with biopsy in children presenting with failure to thrive or feeding difficulties and to determine the extent to which EGD with biopsy results led to a change in diagnosis or clinical management, including medication and nutritional supplements. METHODS: We performed a retrospective cohort study in children under the age of 3 (defined as from 0 up to and including 36 months) who had been seen at one of Boston Children’s Hospital’s outpatient gastroenterology clinics and undergone EGD for the investigation of failure to thrive or feeding difficulties from 1 January 2015 to 31 December 2015. RESULTS: Poor weight gain (55.6%), gastroesophageal reflux (44.4%) and food refusal (38.9%) were the most common presenting symptoms at the first GI clinic visit. The overall prevalence of any gross endoscopic abnormality was 24.8%. The overall prevalence of any histologic abnormality was 44.2%. Compared to subjects with normal esophageal histology, subjects with abnormal esophageal histology had a lower proportion of gastroesophageal reflux and vomiting as their main presenting symptom (63.4% vs. 44.4%, p-value = 0.04). Compared to subjects with normal esophageal histology, subjects with histologic abnormalities in the esophagus were more likely to have current allergy to milk (25% vs. 9.6%, p = 0.02), peanut (8.3% vs. 1.1%, p = 0.03) and tree nut (8.3% vs. 1.1%, p = 0.03). CONCLUSION: In this study gastroesophageal reflux was more prevalent in subjects with normal esophageal histologic findings than those with abnormal findings (63.4% vs. 44.4%, p-value = 0.04). Although the largest number of histologic abnormalities were found in infants, infants were still more likely to have normal than abnormal histology in the esophagus. This finding suggests a more a careful consideration of signs and symptoms prior to proceeding with EGD in infants. Subjects with current milk allergy were more likely to have esophageal histologic abnormalities (p-value = 0.02). Further analysis could indicate current milk allergies as a predictive variable in esophageal histologic abnormalities.

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