Sloughing Esophagitis in the Pediatric Age Group: Clinicopathologic Characteristics of 12 Cases

• Published in: Pediatric and developmental pathology Vol. 28; no. 3; p. 172
• Main Authors: Rubrecht, Ashlie, Saulino, David, Nasri, Elham, Esnakula, Ashwini K, Gonzalo, David H, Feely, Michael M, Beasley, Genie L, Shenoy, Archana
• Format: Journal Article
• Language: English
• Published: United States 01.05.2025
• Subjects: Adolescent; Biopsy; Child; Child, Preschool; Esophagitis - chemically induced; Esophagitis - pathology; Esophagus - pathology; Female; Humans; Infant; Male; Retrospective Studies; Selective Serotonin Reuptake Inhibitors - adverse effects; Young Adult; sloughing esophagitis; esophagitis dissecans superficialis; esophagitis dissecans; pediatric esophagitis
• ISSN: 1615-5742
• DOI: 10.1177/10935266251322063

Sloughing esophagitis (esophagitis dissecans superficialis) is a benign, self-limited condition of uncertain etiology. It is most common in adults; pediatric literature is limited. Ten years of records were queried for esophageal biopsies containing terms "sloughing" and/or "dissecans." Histologic inclusion criteria were "two-tone" appearance, sloughing/flaking of superficial epithelium, and parakeratosis. Degree of inflammation was documented and medical records were reviewed. Fourteen patients were identified ranging from 1 to 19 years (mean = 14 years) and included 3 males and 11 females. Two patients were excluded due to lack of histologic criteria/unavailability of slides for review. Of the 12 cases evaluated, 6 showed a classic inflammation pattern, 5 had minimal or no inflammation, and 1 displayed severe acute inflammation. Endoscopy did not correlate with histology. Sloughing esophagitis is traditionally associated with Selective serotonin reuptake inhibitors (SSRI) use; though 5/12 patients were taking medication for anxiety or depression, only 3 were taking SSRIs. Five patients had marijuana/cannabinoid exposure. Sloughing esophagitis can present in the pediatric population across a wide age range. Similar to the adult population, etiology may be linked to medications. Additional associations such as marijuana/cannabinoid exposure need further clinical investigation. A subset of patients had a history of or subsequently developed eosinophilic esophagitis.