Guvits et al listed risk factors associated with acute esophageal necrosis (AEN). These can help to identify patients for whom the diagnosis might otherwise be missed. The authors are from St. Vincent's Medical Center and New York Medical College in New York City.


Conditions increasing the risk for AEN:

(1) advanced age

(2) male gender

(3) diabetes mellitus

(4) malnutrition

(5) renal insufficiency

(6) atherosclerotic cardiovascular disease

(7) solid organ or hematologic malignancy

(8) hypercoagulability

(9) vasculopathy, including polyarteritis nodosa


Conditions that may precipitate necrosis:

(1) multi-organ failure

(2) hypotension/hypoperfusion

(3) sepsis

(4) diabetic ketoacidosis

(5) alcohol intoxication

(6) gastric volvulus

(7) thromboembolic event

(8) trauma, especially if there is trauma to the thoracic aorta

(9) acute esophagitis (bacterial, viral, fungal)

(10) acute liver disease

(11) upper abdominal surgery

(12) acute pancreatitis

(13) acute immune reaction (hypersensitivity, erythema multiforme, Stevens Johnson syndrome)


The diagnosis of acute esophageal necrosis should be considered in a patient with unexplained upper gastrointestinal bleeding and one or more comorbidities, especially if the onset is after a precipitating event.


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