Etiology and Outcomes of Esophageal Ulcers: A Ten Year Experience in an Urban Hospital
Abstracts
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PURPOSE: Esophageal ulcer (EU) is a rare cause of upper gastrointestinal bleeding. This report describes the etiology, treatment, complications, and outcomes of EU. METHODS: Defined as a discrete break in the esophageal mucosa with a clearly circumscribed margin, EU was seen in 88 patients from a total of 7564 esophagogastroduodenoscopies done by one surgeon at an urban hospital from 1991 to 2001. All hospital reports were reviewed. RESULTS: Etiology of EU was gastroesophageal reflux disease (GERD) (n=58, 65.9%), drug induced (n=20, 22.7%), candidal (n=3, 3.4%) and caustic injury (n=2, 2.3%). Herpes simplex virus, human immunodeficiency virus, marginal ulcer, foreign body, and unknown etiology were also implicated (n=1 each, 1.1%). Morbidity (n=34, 38.1%) included: active hemorrhage (n=20, 22.7%), esophageal stricture (n=11, 12.5%), and esophageal perforation (n=3, 3.4%). Nonoperative therapy sufficed in 78 patients (88.6%). Recurrence of EU occurred in three patients (3.4%). The mean size of GERD induced EU and drug induced EU was 2.78 and 2.92 cm, respectively. 80.3% of GERD induced EU and 13.8% of drug induced EU were located in the lower thoracic esophagus. Fifteen patients (17.0%) required endoscopic intervention including esophageal dilatation for stricture in 11 patients and endoscopic hemostasis for esophageal bleeding in four patients. Operation (n=6, 6.8%) was reserved for esophageal stricture and perforation. One patient died (1.1%) from hemorrhage. CONCLUSIONS: Drug ingestion and GERD are common causes of EU. Midesophageal ulcers have a greater tendency to hemorrhage compared with ulcers at the gastroesophageal junction, and this may reflect etiology. Strictures complicate GERD induced EU rather than drug induced EU. Esophageal dilatation is effective treatment for most strictures associated with EU. EU rarely causes death. |
