2018년 7월 5일 목요일

One more case of black esophagus

[2018-7-4. 애독자 편지]

보내주신black esophagus 증례들을 잘 보았습니다. 최근 한 증례를 경험한 적이 있어 메일 드립니다. 환자는 췌장암 십이지장 침윤으로 stent 삽입을 하는 내시경 도중 진단된 경우입니다. 이후 추적 내시경을 하였는데 상당히 호전된 상태였습니다. 저로서는 black esophagus는 처음 경험해 본 증례였습니다.

당시 주치의 선생님이 경과기록에 문헌고찰을 잘 기록해 놓아 많은 도움이 되었습니다.

Black esophagus: Acute esophageal necrosis syndrome. Grigoriy E Gurvits, World J Gastroenterol 2010 July 14; 16(26): 3219-3225

AEN is thought to arise from a combination of an ischemic insult to the esophagus, impaired mucosal barrier systems, and a backflow injury from chemical contents of gastric secretions. Male sex, older age, chronic medical conditions, including diabetes mellitus, hematologic and solid organ malignancy, malnutrition, renal insufficiency, cardiovascular compromise, trauma, and thromboembolic phenomena place a patient at a higher risk for developing AEN.

ETIOLOGY: A combination of 
1) tissue hypoperfusion 
2) impaired local defense barriers 
3) massive influx of gastric contents

Charicteristic relative sparing of the gastric mucosa can be explained by the acidic impact on the ischemic esophageal and duodenal surface, as well as typically rapid repair of the injured gastric mucosa (within hours) compared to the esophagus (may take days). The duodenal bulb ulcers and edema may result in gastric outlet obstruction that, in turn, potentiates the development of mucosal necrosis of the distal esophagus. Back flow injury from the acid, pepsin, and other gastric contents is augmented by the increased transient lower esophageal sphincter relaxation, decreased resting lower esophageal pressure, prolonged recumbence, decreased esophageal peristalsis, and increased gastroesophageal reflux.

[이준행 답변] 좋은 증례 소개해 주셔서 감사합니다. 

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