Author Age(years S. No )/ Sex Presentation Underlying condition Endoscopic findings Treatment Outcome

circumferential necrotic, hematemesis, alcohol abuse, HTN, fatty friable esophagus with PPI, Ullah et al vomiting, liver disease, CAD, associated friable red transfusions, 1 [5] 50/M unresponsive state. GERD, cocaine abuse. mucosa Sucralfate Died

Gurvits GE DM, HTN, CM, Pleural, Nil-per- et al. [6] Dysphagia, coffee effusions dehydration, Pan-esophageal; gastritis; oral,PPI, 2 62/M ground emesis gastritis, duodenitis duodenitis antibiotics Recovered

Gurvits DM, HTN, Dyslipidemia, Nil-per-os GE et al. Melena, weakness, Hepatitis C, Cirrhosis, PPI Blood 3 [6] 83/M malaise SBP, dehydration ascites Distal transfusion Died

Gurvits Nil-per-os GE et al. DM, CKD, HTN, PPI [6] Dysphagia, Dyslipidemia PVD, Sucralfate hematemesis, Orthopedic surgery, Pan-esophageal; duodenal Blood Recovered, hematochezia, chest duodenal ulcer, ulcer; esophageal transfusion Esophageal 4 75/M pain esophageal candidiasis candidiasis Fluconazol stricture

Gurvits Afib, Sick sinus GE et al. syndrome PPM, OSA, [6] CAD, DM, Dyslipidemia, Epigastric pain, GERD, HTN PE, PNA, Nil-per-os Coffee-ground COPD exacerbation UTI PPI 5 73/M emesis, nausea Gastric ulcers Mid-distal; gastric ulcers Sucralfate Recovered

Gurvits GERD, Alcohol abuse, Mid-distal; hiatal hernia; Nil-per-os Recovered, GE et al. Respiratory failure, PNA gastritis; gastric ulcer; PPI Esophageal 6 [6] 57/F Abnormal CT scan alcohol withdrawal duodenal ulcers Sucralfate stricture

Gurvits Nil-per-os GE et al. PPI [6] Pan-esophageal; Antibiotics HTN, CKD, Gout, Hernia esophageal ulcer; nodular Blood 7 67/M Melena syncope repair GEJ transfusion Recovered

Gurvits Alcohol abuse, Alcohol Nil-per-os GE et al. Hematemesis intoxication, alcoholic PPI 8 [6] 49/M epigastric pain hepatitis Distal Sucralfate Recovered

Gurvits CAD, Afib, CHF, HTN, GE et al. Dyslipidemia, PVD, COPD Nil-per-os [6] Weakness, Vomiting, PUD, Dehydration, PNA Mid-distal; hiatal hernia; PPI Blood 9 86/ M melena Sepsis duodenal ulcer transfusion Recovered

Kalva NR Circumferential blackening et al. [7] of mid-distal esophagus. Hematemesis and Alcoholism, GERD, Hep- Duodenal ulcerations till Hemofiltrati 10 45/F melena. C with CLD. third segment on, Surgery Died

11 Kalva NR 66/F Nausea, coffee DM-2, CAD with CABG, Scattered ulcerations of Insulin Recovered et al. [7] infusion and fluids for DKA and the proximal esophagus high dose ground emesis, and with circumferential PPI for upper retrosternal and essential HTN, and blackening of mid-distal gastrointesti epigastric pain. hyperlipidemia. esophagus. nal bleed.

Inayat F lethargy obtundation. Diffuse, circumferential, et al [8] hypotension, black-appearing, friable Antibiotics, tachycardia hypoxia mucosa in the distal third PPI,TPN 12 52/F hematemesis. DM-1. of esophagus. NPO. Recovered

Shafa S Amputation, et al [9] an Black necrotic mucosa orogastric circumferentially tube. Post- Lower extremity throughout the entire operatively, necrotizing fasciitis esophagus. Additionally, the patient with hypotension, there was disruption of remained fever, leukocytosis, right wall of the hypotensive and AKI requiring esophagus allowing entry and hypoxic emergent into the right pleural despite 13 62/M amputation. Poorly controlled DM. space. intubation. Died

Shafa S Diffuse esophageal et al [9] necrosis as well as a small Injected with Acute onset of chest segment of denuded epinephrine, pain, nausea and HF, COPD, and alcohol mucosa that was actively TPN and 14 63/M hematemesis. abuse. oozing blood. clear liquid. Recovered

Shafa S Left groin infection, Esophageal necrosis from Managed et al [9] surgery for femoral Severe PAD, bilateral the cricopharyngeus to conservative popliteal graft and BKA and left femoral- the gastroesophageal ly with NPO, 15 72/M melena. popliteal bypass graft. junction. IV PPI. Recovered

Shafa S Insulin dependent DM Circumferential necrosis Gastrostomy et al [9] DKA, melena, acute and HTN. Alcoholic, throughout the esophagus tube and anemia, and cocaine, and cannabis and a mid-esophageal supportive Recovered, 16 25/M dysphagia. user. stricture 5 cm in length. therapy. Strictures

Shafa S Hematemesis and ICU and et al [9] acute anemia Pan-esophageal necrosis maximal requiring transfusion HTN, stroke, gallstones, with circumferential medical 17 64/M and IVF. and alcohol abuse. involvement distally. support. Died

Shafa S Due to et al [9] overwhelmin g infection and progressive Fevers, chills, MOF, his weakness, and family syncope that was decided to attributable to Necrosis in the distal third withdraw 18 49/M endocarditis. Asthma and HTN of his esophagus care. Died

19 Galtés I 54/M Unconscious, Alcoholism, multiple The autopsy confirmed the The patient Died et al [10] hyperglycaemia (550 drug addictions and DM- presence of acute bilateral died 24 mg/dL) with ketone bronchopneumonia, hours post chronic pancreatitis, bodies in the urine, severe hepatic steatosis. septic shock, severe At the oesophagus, AEN admission respiratory failure. 1. was evident. due to MOF.

Rigolon R NPO, IV PPI et al [11] and albumin infusion Circumferential necrosis of (TPN for the middle and distal approximate portions of the esophagus ly 15 d). Dysphagia, vomiting, with an abrupt transition Then semi- polyuria, polydipsia at the gastroesophageal liquid diet Recovered, 20 50/M and low-grade fever. DM-2 and HTN. junction. was started. Strictures

Iorio N et Necrotic-appearing pan- al [12] esophagitis in the upper third and lower third of esophagus, severely Managed Abdominal pain, ulcerated, necrotic conservative diarrhea, nausea, and kidney transplant, DM-2, duodenitis in the second ly with IVF 21 63/F vomiting. HSP and PAD. portion of duodenum. and IV PPI. Recovered

Salem GA Hematemesis and 22 et al [13] 62/F severe hypothermia Alcoholic cirrhosis.

Abu-Zaid NPO, IVF, A et al Circumferential black analgesia, [14] Medical and surgical pigmentation, fragile TPN, IV PPI history were notable for esophageal necrotic and pancreatic vasoactive mucosa, and multiple ranitidine. 2 Severe epigastric intestinal peptide- superficial ulcerations in units of pain, coffee-ground producing tumor; the middle and lower packed red 23 40/M emesis, and fatigue. resected 18 months ago. thirds of esophagus. blood cells. Recovered

Tse A et Surgical al [15] intervention PMH included alcohol for abuse, epilepsy and esophagecto GERD leading to stricture my and formation and two A gastrografin swallow anastomosis Severe hemodynamic biodegradable stent confirmed an esophageal . A feeding Recovered, 24 58/M shock. insertions for that. perforation. jejunostomy. Strictures

Talebi- Hematemesis, Bakhshay abdominal pain, DKA and esh M et nausea, vomiting, appropriate al [16] fatigue and Black esophagus with the treatment 25 34/M disorientation. Insulin dependent DM. proximal third spared. was started.

Lin MC et Diffuse black pigmentation al [17] with extensive ulcerative Hypertensive mucosa in the mid-to- cardiovascular disease, distal esophagus as well Oral DM with CRF, AF, sick as sharp demarcation at sucralfate Melena and sinus syndrome and the gastroesophageal (GE) and PPI for 2 26 70/M hematemesis. prostatic CA. junction. weeks. Recovered

27 Tsao C et 73/M coffee ground emesis. HTN,COPD and a 57- At the time of autopsy, the He was Died al [18] pack-year smoking and decedent was described pronounced as cachectic and diffuse dead shortly Alcohol abuse. blackening of esophagus. after arrival.

Zacharia Managed GS et al with IVF, PN, [19] parenteral PPI, Nausea, hematemesis antiemetics and retrosternal chest and 28 62/F discomfort. DM and HTN. Black distal esophagus. sucralfate. Recovered

Worrell Managed SG et al conservative [20] ly with antibiotics, Melena and Black mucosa but no NG tube, 29 84/M hematemesis. cirrhosis evidence of perforation. and NPO. Recovered

Worrell SG et al Nausea, chest pain, Black mucosa in the distal 30 [20] 84/M and hematemesis. DM and HTN esophagus. NPO, TPN. Recovered

Worrell Emergent SG et al surgery and [20] an esophagecto my with cervical diversion Hematemesis and Black esophagus with was 31 77/M diarrhea. Cirrhosis and DM distal perforation. performed. Died

Nikolić S The autopsy showed the et al [21] acute necrotizing esophagitis and the acute gastric and duodenal 32 76/M HTN and DM. erosions of mucosa. Died

Abed J et Continuous ulcerated and al [22] darkened necrotic esophageal mucosa from 20 cm beyond the incisors Managed Diffuse abdominal to the gastroesophageal conservative 33 80/F pain with melena. UC and GERD. junction. ly with TPN. Recovered

Hermet A Hematemesis and IV PPI, TPN, et al [23] epigastric pain one and red day after the surgical blood cell 34 72/M intervention. CAD, PAD, DM and HTN. Necrosis of the esophagus. transfusion. Recovered

Groenvel Stenting d RL et al was [24] considered, but due to friable Severe dyspnea due mucosa and to left sided tension perforation pneumothorax and Hemicolectomy for CA Perforated black an Recovered, 35 68/F chest tube insertion. colon and chemotherapy. esophagus. intrathoracic Strictures flushing- system was placed through VATS.

Lahbabi The upper third of the M et al esophagus was [25] circumferentially congestive but the mid to lower third showed DM, HTN and amputation circumferential black Septic shock, of right leg for diabetic pigmentation associated TPN and IV 36 60/M hematemesis. arteriopathy. with diffuse bleeding. PPI. Died

Hejna P Toxicology analysis et al [26] revealed a fatal blood Patient died level of antipsychotics due to Found dead on the (haloperidol, zotepine, On autopsy black neuroleptic 37 53/F floor in her flat. and chlorprothixene). esophagus was found. intoxication. Died

Pereira O Extensive candidiasis and IVF, nutrition et al [27] a black-appearing and Dehydration and poor esophageal necrosis at the esophageal Recovered, 38 62/F nutritional status. chronic alcohol abuse. distal 2/3. dilatation. Strictures

Venara A elderly Black esophagus was 39 et al [28] man Found dead. identified during autopsy. Died

Kanapart NPO, hi C et al Erythematous upper third managed [29] of esophagus, with IVF, Epigastric pain, CAD, CHF, stroke, DM 2, circumferential areas of strict nausea followed by HTN, dyslipidemia, black necrosis, ulceration glycemic coffee ground emesis asthma and age related in the middle and lower control and 40 76/F and melena. dementia. third of esophagus. IV PPI.

Yagain K Recurrent episodes of Denuded esophageal et al [30] hematemesis and mucosa with hemorrhage Symptomati 41 54/M melena. Alcoholic. and blackish discoloration c Treatment Recovered

Unuma K A postmortem et al examination revealed [31] Found dead with marked black coloring of Elderly coffee-ground the esophagus from the 42 male vomiting. Alcohol abuse upper to the bottom end. Died

Altenburg On autopsy examination, er DL et cocaine and alcohol the esophagus was black 43 al [32] 45/F Found unresponsive. abuse. with ischemic necrosis. Died

44 Garas G 89/F Acute epigastric pain Hiatus hernia . CT of the thorax and Left lateral Died et al [33] abdomen showed large thoracotomy hiatus hernia with to retrieve a mesentero-axial volvulus healthy but no evidence of oesophageal strangulation. A mural segment, thrombus in aneurysm of which was aortic arch and anastomose descending aorta. d to the cardiac end of the stomach.

Choi EJ et Diffuse friable black al [34] colored mucosa at whole Conservativ length of the esophagus e treatment 45 48/M Hematemesis Alcoholic hepatitis. was observed. with IV PPI. Recovered

Pramparo Black discoloration of the SE et al Upper gastrointestinal distal esophagus with 46 [35] 80/M bleeding. proximal extension.

Kim IK et Circumferential black al [36] coloration on middle to lower esophagus. Pyloric Conservativ ring deformity and active e duodenal ulceration with managemen Hematemesis after extensive edema was t with NPO 47 53/M repeated vomiting. observed. and IV PPI. Recovered

Eren B et During autopsy acute al [37] esophageal necrosis with Died soon Abdominal distention black colored esophageal after 48 17/F and vomiting. mucosa was detected. admittance. Died

Wallberg Resuscitated ME et al Esophageal necrosis with with IVF, [38] areas of slough and vasopressor heartburn, vomiting erosions in the stomach drugs and 49 75/M and septic shock. HTN. antrum. antibiotics. Recovered

Pastuszak Gastrointestinal M et al bleeding and [39] hemodynamic 50 87/F dysfunction.

Neumann Retrosternal chest DA 2nd pain associated with et al [40] lightheadedness, Treated with diaphoresis, and IVF and 51 79/M dyspnea. DM, HTN, CAD and CRF. atropine. Recovered

Hong Supportive JW et al care with IV [41] PPI, sucralfate, and TPN resulted in the remarkable healing of the Proximal-to-mid diffuse esophageal DM, HTN, alcohol abuse esophageal candidiasis wall with no Copious and gastric ulcer, an old and black-colored mucosa complication 52 85/M hematemesis. CVA. in the lower esophagus . s. Recovered

53 Hwang J 84/F Coffee ground emesis HTN, CKD, degenerative Diffuse dusky esophageal ICU, IVF, IV Recovered et al [42] mucosa with sloughing and a paraesophageal hernia. A small non- and H/O persistent joint disease, and bleeding gastric ulcer was PPI and vomiting. paroxysmal AF. also noted. antibiotics.

Nagri S et Treated with al [43] Grade D esophagitis with IVF, Well-controlled blackish discoloration of sucralfate Coffee-ground emesis schizophrenia and the mucosa in lower third by mouth, 54 54/M and melena. mentally ill. of the esophagus. and IV PPI. Recovered

Burtally A IV PPI, two et al [44] units of packed PAD. Myoglobinuria with RBCs and A DRE showed ARF. Left facial heparin was melena. A NG tube hemiparesis and left Black esophagus in the reversed drained 1.3 L of dark upper limb paresis acute middle and distal one- with IV 55 77/M brown liquid. confusion. third. protamine. Recovered

Husová L Acute esophageal necrosis et al [45] Hematemesis and With tumor in more than 2/3 of the IVF and IV 56 56/M melena. dissemination. oesophagus. PPI. Died

Khan AM IVF, IV PPI et al [46] EGD revealed a and blood HTN, chronic alcohol continuous segment (15- transfusion Aggressive behavior, abuse, CLD, chronic 35 cm) of necrosis in the with 3 units depression and pancreatitis and middle and distal of packed 57 59/M. suicidal ideation. depression. esophagus. RBCs. Recovered

Odelowo Severe retrosternal Circumferential black OO et al and epigastric pain, HTN, emphysema, areas of necrosis, [47] vomited coffee hypercholesterolemia ulceration in entire lower Sucralfate 58 61/M grounds thrice. and CKD. 3/4th of the esophagus. and PPI. Died

Reichart Low anterior resection Conservativ M et al Severe interscapular for a villous adenoma in Black mucosa of the entire e treatment 59 [48] 73/M pain. the rectosigmoid. esophagus. with IV PPI. Recovered

Benoit R State of shock with TPN and IV 60 et al [49] 48/M hematemesis. PPI. Recovered

Choksi V nil-per-os (NPO) and et al [50] started on intravenous (IV) fluids, IV proton pump inhibitor coffee ground emesis, demonstrated black, (PPI) with a positive fecal circumferential necrosis of therapy, IV occult blood test the mucosa of the cervical antibiotics, (FOBT) and esophagus without and IV 61 65/M melena,DKA episode CAD, DM, andPAD bleeding steroids Recovered

62 Padda A et 68/F Coffee ground Antiphospholipid endoscopy revealed emesis, hypotension, syndrome (APS), SLE, “black esophagus” al [51] involving the middle and an acute drop in her lower portions of the Hgb concentration lupus nephritis esophagus

Bonaldi M hemotransfu et al [52] sion, total parenteral EGD showed a nutrition and circumferentially black- high-dose appearing mucosa at the proton pump Whipple Resection of inferior third of the inhibitor 63 72/M hematemesis ampulla of vater tumor esophagus (PPI) Recovered

Cameron black mucosa from the PA et al proximal esophagus to the [53] unresponsive at gastroesophageal home, hypovolemic junction. Biopsies showed and hypothermic, CAD, HTN, dyslipidemia, acute necrotizing confused and DM-2, and active alcohol esophagitis with diffuse 64 62/M jaundiced use brown pigment. Recovered

Alcaide N esophageal lumen et al dysphagia, feeling diffusely dilated, with intravenous food bolus impaction HTN, CKD, Schatzki submucosal hemorrhages hydration [54] and intense epigastric stenotic ring (treated 3 and confluent violet- and high 65 80/M pain months back) blackish areas dose PPI Recovered

Sakatoku Y intensive et al care, debridement [55] , and treatment Recovered,S septic shock with DKA black mucosal coloration with trictures due to necrotizing throughout the entire antibiotics developed 1 66 61/M hematemesis fasciitis esophagus and a PPI month later

Pineo CE PPI, et al [56] intravenous opioids and nasogastric tube epigastric pain of insertion for one-day duration, presumptive haematemesis and cocaine, bupropion and small bowel 67 30/M weakness amphetamine overdose oesophageal necrosis obstruction Died

Galtés I et Dark coloration with clear al [57] boundaries around the circumference and along the whole length of the oesophageal mucosa, with an abrupt transition at the alcoholism, multiple drug level of the gastro- 68 54/M found unconscious addictions, and DM-1 oesophageal juncture Died

Sharma V diffuse blackish intravenous et al discoloration of the fluconazole esophagus that was more intravenous [58] odynophagia and systemic lupus prominent in the lower amphoterici 69 26/F hematemesis erythematosus (SLE) esophagus, suggesting n was Died AEN. Histology revealed initiated and intravenous antibiotics were upgraded (i.e., to piperacillin, tazobactam, vancomycin from the the presence of candida in previous the form of pseudohyphae ceftazidime) and an inflammatory , but the infiltrate that was patient died consistent with AEN of sepsis.

Koop A et black circumferential al [59] necrosis in the lower two- generalized weakness thirds of the esophagus and symptomatic idiopathic ESRD, primary consistent with acute 70 62/M hypotension adrenal insufficiency esophageal necrosis (AEN) Died

schizoaffective disorder accidentally took Pautola L another patient’s et al [60] medication, including clozapine 300 mg, olanzapine 30 mg, vomit brownish liquid teofyllamine 200 mg, and had tachycardia warfarin 5 mg, and necrotic esophageal 71 65/M and fever potassium chloride 1 g mucosa Recovered

Joubert aortic dissection KD et al extending from the left [61] acute onset of chest subclavian artery pain and progressive through the common Esophageal necrosis 72 66/M dyspnea iliac arteries complicated by rupture Recovered

Dos 2nd postoperative Santos R day, she presented blackened areas, from the et al [62] upper gastrointestinal esophagus middle third, bleeding, advanced rectosigmoid occupying the entire hematemesis, with junction circumference of the diet hematimetric impact, adenocarcinoma. organ, which was suspension requiring red blood rectosigmoid resection compatible with acute initially, PPI, 73 53/F cell transfusion operation esophageal necrosis hydration Recovered

Busch D et severe infectious Endoscopy revealed al [63] mononucleosis significant arterial intermittent complicated by bleeding from a wide ulcer hemoptysis and tarry fulminant hepatic failure, located in the distal 74 18/M stools splenic rupture esophagus surgery Recovered

Kwon HJ showed black macerated et al [64] mucosa in the mid third of the esophagus and circumferential mucosal necrosis with a huge adherent blood clot in the distal third of the 75 67/F hematemesis CAD, undergoing PCI esophagus PPI Recovered Efthymakis infusion of a K et al colloidal [65] solution, two endoscopy showed a black units of Recovered, erosive gastritis, alcohol- mucosa ([Fig. 1 a]) that packed red Complicated abdominal pain, related CLD, and chronic started from the upper blood cells, by schatzki hematemesis, and pancreatitis,blood esophagus and ended a PPI, and ring 2.5 76 75/M melena pressure was low abruptly at the cardia terlipressin months later

Edling P et diabetic ketoacidosis al [66] and severe sepsis, later presenting an Recovered, acute necrotizing esophageal 77 67/M esophagitis DM, AFib and CKD stenosis,

Del Hierro EGD showed the PM et al esophagus with [67] DM 2, HTN, and usual circumferential black intake of Nonsteroidal coloration extending from Omeprazol hematemesis and Anti-inflammatory drugs 23 cm to the gastro- and 78 81/F epigastralgia (NSAID) for joint pain esophageal junction Sucralfate Recovered

Carrera VG DM 2, HTN, ischemic et al [68] an episode of coffee- cardiomyopathy and 79 84/M ground vomit CKD

Messner Z hematemesis, massive bleeding in the et al [69] melena, and upper gastrointestinal abdominal pain, tract, macroscopic Stent 80 45/M hypovolemic shock necrosis, ulceration placement Recovered

Grudell AB AAA, HTN, et al [70] hyperlipidemia, hx of MI, DM2, ESRD on HD, AF, PVD, prostate CA, Necrotic debris with small 81 79/M Hematemesis hypothyroidism amount of brown pigment PPI Died

Grudell AB Ciprofloxaci et al [70] n, metronidazo Recovered, Left nephrectomy for Necrotic debris with brown le, Distal Epigastric pain with cystic kidney, right hip pigment; iron and melanin pantoprazol esophageal 82 80/M sour taste fracture, DM, HTN, CRI stains negative e stricture

Grudell AB Metastatic epithelioid et al [70] sarcoma with Death from Nausea, vomiting, chemotherapy 5 months Necrotic debris with brown Fluconazole, metastatic 83 29/M dysphagia prior pigment rabeprazole sarcoma

Grudell AB Valacyclovir, et al [70] PUD, cholecystectomy, levofloxacin, right inguinal hernia metronidazo repair, right ankle No biopsy specimens le, 84 73 M Hematemesis fracture taken of black esophagus lansoprazole Recovered

85 Grudell AB 49/M Melena CVA, hyperlipidemia Necrotic debris with large High-dose Recovered et al [70] amount of brown pigment steroids, cyclophosph amide, pantoprazol e

Grudell AB DM-1, HTN, et al [70] Hematemesis, hyperlipidemia, left epigastric pain, elbow fracture, ethanol No biopsy specimens Pantoprazol 86 41/M odynophagia binge taken of black esophagus e Recovered

Trappe R hydration et al [71] and nutrition, as well as aggressive acute esophageal necrosis acid in the distal part of the suppression esophagus, CMV- with polymerase chain reaction intravenous (PCR) was positive, and a proton pump ESRD on hemodialysis CMV-pp65 antigenemia inhibitors for 8 years. Kidney donor assay revealed 65/10,000 and severe epigastric pain was CMV-IgG positive. Pt CMV-pp65-positive blood sucralfate 87 54/M and malaise acquired CMV leukocytes. suspension Recovered

Singh D et Nasogastric al [72] tube, PPI IV daily, broad- Altered mental status, Blackened esophagus, spectrum pneumo- DKA, seizure disorder, necrotic appearing pale antibiotics, mediastinum, acute amphetamine abuse, esophageal mucosa, and antifungal 88 25/F renal failure Candidemia normal GE junction agent Recovered

Singh D et NPO, PPI IV al [72] twice daily, 100 units of Dysphagia, botulinum hematemesis, acute Achalasia, CHF, anemia, Necrotic appearing friable toxin renal failure, severe heavy alcohol, tobacco, areas of spontaneous injected at 89 49/M GERD cocaine use bleeding LES. Recovered

Singh D et Dusky appearance in NPO, PPI IV al [72] Renal transplant in distal 10 cm of esophagus twice daily, rejection, DM, PVD, HD, with areas of superficial total Epigastric pain, ischemia, ulceration suggestive of parenteral 90 50/M nausea immunodeficiency ischemia nutrition Died

Singh D Resected pancreatic et al [72] cancer, nephrectomy for PPI IV twice Syncope, renal cancer, resected Diffuse blackened daily, broad hypotension, nausea, hepatic adenoma, DM, esophageal mucosa, spectrum 91 60/F vomiting, GI bleed HTN, CHF, ESRD on HD friable mucosa antibiotics Died

Singh D Nausea, vomiting, GI DKA, GERD, heavy Middle to distal esophagus NPO, PPI IV 92 et al [72] 36/M bleed smoking appeared necrotic twice daily Recovered

93 Wu MH et 46/M 7 days of epigastric 15-year history of Day 1: black discoloration transhiatal Recovered al [73] pain, nausea and alcohol abuse, 2-year of the mucosa in the lower esophagecto vomiting and 3 days history of frequent esophagus.Day 2: my and of hematemesis and gastrointestinal ulcer revealed sloughing of esophageal tarry stool bleeding some esophageal mucosa. reconstructi Day 6: performed on day on using a 6, revealed mucosal sloughing extending upward to involve the entire thoracic esophagus. Day 19: endoscopy performed postoperatively confirmed partial necrosis of the esophageal stump and duodenal ulcer gastric bleeding tube,PPI

Wu MH et Day 2: the first endoscopy al [73] revealed an active gastric ulcer, duodenal ulcers, and black discoloration of the lower esophageal mucosa,Day 9: the second Sengstaken– endoscopy revealed Blakemore mucosal sloughing in the tube was 2-day history of tarry lower esophagus. Day 10: placed to stools following a the third endoscopy control right femoral neck revealed necrosis of the continuous Died, fracture suffered 3 stroke 3 months mucosa, extending to the esophageal Esophageal 94 67/M days back previously, HTN middle thoracic esophagus bleeding rupture

Aloreidi K coffee ground emesis black discoloration of the et al [74] with no associated HTN, tobacco mucosa of the distal melena or dependence, COPD, and esophagus and altered PPI and 95 58/F hematochezia Afib. blood in the gastric fundus sucralfate Recovered

Kim, D et Recovered, al [75] Patient developed stenosis and subsequentl y tracheoesop Dysphagia, Shock hageal from internal fistula from hemorrhage post- black discoloration with a stent 96 51/F transplant surgery Liver cirrhosis severe stricturing conservative placed in.

Jeyalinga near-circumferential, PPI, m T et al black, necrotic-appearing, Sucralfate,D [76] esophageal mucosa from KA the mid esophagus to the managemen 97 55/F coffee-ground emesis DKA, Type II DM gastroesophageal junction t Recovered

Manno V Widely ulcerated et al [77] esophageal mucosa, from superior esophageal sphincter toward cardiac sphincter, that is relaxed. PPI, NPO, IV Slight hyperemia of gastric fluconazole, 98 49/M Bloody emesis. Type II DM, sepsis antral mucosa acyclovir Recovered Osterman severe diffuse ulceration MT et el beginning in the mid [78] abdominal distension esophagus (Fig. 2a), with and new onset of continued severe copious foul-smelling ulceration throughout the Not 99 66/M hematemesis schizophrenia distal esophagus mentioned Died

Brar TS et found covered in her al [79] own emesis, was in hypovolemic shock, tachycardic, severe mucosal changes hypotensive, and characterized by necrosis unable to follow Alcohol abuse, at the middle and lower PPI,octreotid 100 59/F commands depression thirds of the esophagus e Recovered

Choksi V coffee ground emesis, black, circumferential et al [80] with a positive fecal necrosis of the mucosa of occult blood test the cervical esophagus 101 65/F (FOBT) and melena CAD, DM, PAD without bleeding PPI, Recovered

Shah A et black interspersed with al [81] erythematous mucosa which was friable and granular and had decreased vascular Alcohol, PCP, pattern in the middle third coffee ground emesis, methadone, and lower third of the PPI,transfusi 102 66/F post cardiac arrest benzodiazepine abuse esophagus ons Died

Matsuo T black esophagus with et al [82] ulcerated longitudinal hematemesis and necrosis in the lower 103 63/F black stool DM TII esophagus PPI Recovered

Bonaldi M PPI, et al [83] circumferentially black- transfusions, Ampulla of vater appearing mucosa at the Total neoplasm, post whipple inferior third of the parenteral 104 72/M hematemesis. procedure esophagus nutrition Recovered

Alcaide N esophageal lumen et al [84] dysphagia, feeling diffusely dilated,with food bolus impaction submucosal hemorrhages and intense epigastric HTN, Schatzki rings, and confluent violet- 105 80/M pain hiatal hernia blackish areas PPI Recovered

PPI, IV fluids, circumferential necrotic, blood hypotension and ESRD on hemodialysis, friable oesophagus transfusion, vomiting during DM, dementia, PE with extending from 21 cm to NPO, 106 This case 90/F hemodialysis session IVC filter placement, 38 cm from the incisors sucralfate. Died,

Table 1: characteristics of 105 patients with black esophagus, extracted from previous case reports and series.