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

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 7564 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%). Nonoperarive 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 I I 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%) (lied from complications of esophageal ulcers: hemorrhage in one and perforation in one. Three patients (lied 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 nor drug-induced esophageal ulcers. Esophageal dilatation is an effective treatment for most strictures associated with esophageal ulcers. Esophageal ulcers rarely cause death. (C) 2003 The Society for Surgery of the Alimentary Tract