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Researchers describe a patient with a “candy cane appearance” of the esophagus, due to acute thermal injury, in the October issue of Clinical Gastroenterology and Hepatology. Upon further investigation, the authors found that the patient had poured hot boiling tea into his throat.


Arun AC and Jenish Rajma describe the case of a 19-year-old boy who presented to the emergency department with a history of hematemesis for 1 day. He denied drinking alcohol and had no recent history of analgesic use. A physical examination found nothing remarkable, except for pallor.
Endoscopic evaluation showed diffuse ulcerations of the esophagus with alternate linear white and red bands, giving a candy-cane appearance (see figure). This features has been previously reported in patients with acute thermal injury to the esophagus.
The patient admitted to pouring hot boiling tea directly into his throat as part of a local competition. The flow of hot liquid over the esophageal mucosa caused the red and white bands observed by endoscopy. The finding highlights the importance of considering ingestion.
The patient was treated with parenteral nutrition for 1 week, an intravenous proton pump inhibitor (esomeprazole), and sucralfate. He did not have further episodes of hematemesis and did not develop dysphagia. He was discharged after 10 days of hospitalization. Subsequent endoscopy after 1 month showed a completely normal esophageal mucosa without any strictures.

Acute esophageal thermal injury occurs mostly after drinking hot liquids or swallowing solid foods. Its occurrence is more common in Eastern vs Western cultures, because of differences in foods and drinks.

Patients most frequently present with odynophagia, chest pain, hematemesis, and melena. Endoscopic evaluation shows alternating white and red linear mucosal bands, esophageal ulcers, or pseudomembranes.

The authors explain that most patients respond well to conservative management with parenteral nutrition, proton pump inhibitors, and sucralfate. They usually have complete healing of the esophageal mucosa within 1 month.

However, esophageal perforation can occur on rare occasions, although long-term complications are uncommon.

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Kristine Novak

Kristine Novak

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About The Author:

Dr. Kristine Novak

Dr. Kristine Novak

Dr. Kristine Novak is a science writer and editor based in San Francisco. She has extensive experience covering gastroenterology, hepatology, immunology, oncology, clinical, and biotechnology research discoveries.

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