Comprehensive Clinicopathological Analysis of Sloughing Esophagitis: A Large Single-center Series

Sloughing esophagitis (SE), a.k.a. esophagitis dissecans superficialis, is a desquamative disorder of the esophagus characterized by superficial squamous cell layer sloughing with normal underlying mucosa. The etiology is poorly understood. We collected 72 SE cases spanning 15 years from our health system and investigated their clinicopathological features. Endoscopic findings of SE usually included characteristic sloughed mucosa with strips or ribbon-like mucosal breaks, though rare cases had normal upper endoscopy. Histologically, there was two-toned appearance with superficial parakeratosis in all cases. In our study, while the majority of SE (57%) were completely devoid of inflammation, 43% of them exhibited neutrophilic / lymphocytic inflammation (2 were severe). Fifty-seven patients (79%) were taking 5 or more prescriptions, most commonly NSAIDs and/or antiplatelets/anticoagulants (39%). Twenty patients (28%) had malignancy, and additional eleven patients (15%) were on immunosuppressive therapy. Although the precise pathogenesis of SE is unknown, it appears that it was associated with polypharmacy, malignancy, and/or immunosuppression. Acid suppressants were prescribed as the treatment for 83% SE patients. Most patients resolved at follow-up. The presence of inflammation at initial biopsy does not appear to be related to any identifiable etiology or clinical outcome.