Chronic esophagitis dissecans: An unrecognized clinicopathologic entity?

Background: We report the clinical and histologic features of a distinctive form of chronic esophagitis for which we propose the term chronic esophagitis dissecans. Methods: The study group included five patients diagnosed at Hopital Beaujon, Clichy, from 1988 to 1994. Clinical and endoscopic examinations were performed. Samples of esophageal biopsy specimens were analyzed by histologic and ultrastructural examinations and by immunohistochemistry with antibodies directed against cell adhesion molecules. Results: All patients were elderly (mean age, 66 years). They presented the following combination of clinical and endoscopic features: (1) long-standing history of chronic dysphagia, without symptoms of reflux, (2) shedding of mucosal fragments, occurring spontaneously or after mechanical trauma, (3) existence of localized esophageal strictures, (4) lack of concurrent chronic cutaneomucous lesions. Two patients presented with thymoma. Histologic examination showed evidence of mucosal blistering, in the absence of significant inflammatory lesions. Altered cell-cell adhesion was suggested by the reduced number of desmosomes on ultrastructural examination and the decreased expression of immunoreactive intercellular adhesion molecule E-cadherin. Conclusion: Chronic esophagitis dissecans likely represents a hitherto unrecognized clinicopathologic entity and must be added to the causes of chronic dysphagia.