Acute esophageal necrosis: A rare but potentially life-threatening condition—Insights from a case series

Acute esophageal necrosis (AEN) is a rare and severe entity characterized by diffuse necrosis of the mucosa, mainly in the distal esophagus, with a mortality rate close to 40%. We present herein six cases diagnosed through upper gastrointestinal endoscopy. The mean patient age was 62 years (range 33–86) and females were predominant (5/6). The most frequent comorbidities were diabetes mellitus and high blood pressure (5/6, each entity). The main symptoms included melena, hematemesis, and epigastric pain. Two patients presented with diabetic ketoacidosis and sepsis. Endoscopy revealed diffuse necrosis in all the cases and perforation in two cases. Two patients were discharged from the hospital, one received palliative care, and two died due to multiple organ failure (40% mortality). Management included proton pump inhibitors, antibiotics, antifungals, and nutritional support. AEN requires early diagnosis and a multidisciplinary approach to prevent major complications, such as bleeding and perforation. La necrosis esofágica aguda (NEA) es una entidad rara y grave, caracterizada por necrosis difusa de la mucosa, principalmente en el esófago distal, con mortalidad cercana al 40%. Presentamos seis casos diagnosticados por endoscopia digestiva alta. La edad media fue 62 años (rango 33–86), con predominio femenino (5/6). Las comorbilidades más frecuentes fueron diabetes mellitus e hipertensión (5/6 cada una). Los síntomas principales incluyeron melena, hematemesis y dolor epigástrico. Dos pacientes cursaron con cetoacidosis diabética y sepsis. La endoscopia mostró necrosis difusa en todos los casos, identificándose perforación en dos. Dos pacientes egresaron, uno recibió cuidados paliativos y dos fallecieron por falla orgánica múltiple (40% mortalidad). El manejo incluyó inhibidores de bomba de protones, antibióticos, antifúngicos y soporte nutricional. La NEA requiere diagnóstico temprano y abordaje multidisciplinario para prevenir complicaciones mayores como hemorragia y perforación.