Florian Schertl et al describe the case of a 55-year-old woman with new retrosternal pain upon swallowing. She had been receiving continuous and successful proton pump inhibitor therapy for gastroesophageal reflux disease for years. Esophageal pH metry and impedance analysis while she was on this treatment showed neither abnormal acidic nor nonacidic reflux. Esophagogastroduodenoscopy confirmed the absence of any erosions at the gastroesophageal junction.
However, shredded whitish membranes covered almost the full length of the esophagus, forming tubes that were 4 to 5 cm long and easily detached from the underlying intact mucosa and pulled out perorally (see figure A; Video). Histology analysis of the esophageal wall revealed only mild submucosal inflammation without eosinophilic infiltration, candidiasis, viral infection, or deposits of immunoglobulins or complement. The membranes consisted of superficial layers of squamous epithelium (see figure panel B) that lacked a basal cell layer or signs of inflammation.
Treatment with oral budesonide did not reduce the symptoms or endoscopic features. The patient denied taking any medication other than pantoprazole and atorvastatin. However, she mentioned that for several months she had come accustomed to drinking extremely hot coffee.
Schertl et al therefore made a diagnosis of exfoliative esophagitis caused by thermal injury. Twelve weeks after abstaining from hot beverages, the esophageal mucosal exfoliation completely disappeared.