Etiology, treatment, and outcome of esophageal ulcers: a 10-year experience in an urban emergency hospital

• Published in: Journal of gastrointestinal surgery Vol. 7; no. 7; pp. 836 - 842
• Main Authors: Higuchi, Daisuke, Sugawa, Choichi, Shah, Sachin H, Tokioka, Satoshi, Lucas, Charles E
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01.11.2003
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Esophageal Diseases - diagnosis; Esophageal Diseases - epidemiology; Esophageal Diseases - etiology; Esophageal Diseases - therapy; Esophagoscopy; Female; Gastroesophageal Reflux - complications; Herpes viruses; Hospitals, Teaching; Humans; Incidence; Male; Middle Aged; Throat; Ulcer - diagnosis; Ulcer - epidemiology; Ulcer - etiology; Ulcer - therapy; Urban Population
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-003-0027-7

Esophageal ulcers are a rare cause of upper gastrointestinal bleeding. This report describes the etiology, treatment, complications, and outcome of esophageal ulcers. An esophageal ulcer is defined as a discrete break in the esophageal mucosa with a clearly circumscribed margin; esophageal ulcers were seen in 88 patients from a total of 7,564 esophagogastroduodenoscopies done by one surgeon at an urban hospital from 1991 to 2001. All hospital reports were reviewed. The etiology of esophageal ulcers included the following: gastrointestinal reflux disease (GERD) (n=58, 65.9%), drug induced (n=20, 22.7%), candidal (n=3, 3.4%), caustic injury (n=2, 2.3%), and herpes simplex virus (HSV), human immunodeficiency virus (HIV), marginal ulcer, foreign body, and unknown etiology (n=1 of each, 1.1%). The mean size of GERD-induced esophageal ulcers and drug-induced esophageal ulcers was 2.78 and 2.92 cm, respectively; 80.3% of GERD-induced esophageal ulcers and 13.8% of drug-induced esophageal ulcers were located in the lower thoracic esophagus. Morbidity (n=44, 50%) included hemorrhage (n=30, 34%), esophageal stricture (n=11, 12.5%), and esophageal perforation (n=3, 3.4%). Nonoperative therapy sufficed in 81 patients (92%). Three patients (3.4%) had a recurrence of esophageal ulcers. Fifteen patients (17.0%) required endoscopic intervention including esophageal dilatation for stricture in 11 patients and endoscopic hemostasis for esophageal bleeding in four patients. Surgery (n=7, 8.0%) was reserved for esophageal stricture and perforation. Two patients (2.3%) died from complications of esophageal ulcers: hemorrhage in one and perforation in one. Three patients died of their primary disease. GERD and drug ingestion are common causes of esophageal ulcers. Midesophageal ulcers have a greater tendency to hemorrhage compared with ulcers at the gastroesophageal junction; this may reflect the etiology. Strictures complicate GERD-induced esophageal ulcers but not drug-induced esophageal ulcers. Esophageal dilatation is an effective treatment for most strictures associated with esophageal ulcers. Esophageal ulcers rarely cause death.