Esophagitis Dissecans Superficialis: A Rare Cause of Dysphagia

Esophagitis dissecans superficialis (EDS) is a rare benign esophageal lesion characterized by sloughing of the esophageal mucosa. The presentation is either dysphagia or odynophagia, and the diagnosis relies on endoscopic appearance, with histopathology being nonspecific. We report this case of a 71-year-old male diabetic with chronic kidney disease on maintenance hemodialysis, having weight loss and dysphagia of 3 weeks duration. Upper endoscopy showed severe mucosa [changes with sloughing in the lower esophagus with bluish discoloration, consistent with EDS]. Histopathology showed necrosis and parakeratosis which corroborated the diagnosis. No offending agents were identified, and high-dose proton pump inhibitors (PPls) and sucralfate were initiated, resulting in symptom improvement. EDS, even though rare, remains poorly understood. Mostly the etiology is idiopathic even though it is associated with medication use, esophageal motility disorders, and autoimmune conditions.