Clinical journal of gastroenterology · 2026
Acute esophageal necrosis in patients with diabetic ketoacidosis: a systematic review of clinical features and outcomes.
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Itagaki Hideya, Endo Tomoyuki
Аннотация
BACKGROUND: Acute esophageal necrosis (AEN) is a rare but serious disorder that occurs in critically ill patients. Although diabetic ketoacidosis (DKA) is a recognized precipitating factor, the clinical characteristics of DKA-associated AEN have not been well defined. This systematic review aimed to summarize the clinical presentation, endoscopic findings, management, and outcomes of AEN occurring in patients with DKA.
METHODS: A systematic literature search of PubMed and Web of Science was conducted from database inception to March 31, 2026, in accordance with PRISMA 2020. Eligible studies reported AEN confirmed by upper gastrointestinal endoscopy or postmortem examination occurring in association with DKA and provided sufficient case-level clinical data. Case reports and case series were included. Data were synthesized narratively.
RESULTS: Thirty-six studies involving 39 patients with DKA-associated AEN were included. The median age was 55.0 years (interquartile range [IQR], 49.0-65.0), and 29 patients (74.4%) were male. Overt upper gastrointestinal bleeding was reported in 28 of 32 evaluable cases (87.5%), although 10 patients (25.6%) developed bleeding only after admission. Shock or hypotension was present in 18 of 34 cases (52.9%). Endoscopy was performed in 34 cases (87.2%). AEN extent was evaluable in all 39 cases based on endoscopic or postmortem descriptions; 25 patients (64.1%) had mid/distal-predominant involvement, whereas 14 patients (35.9%) had involvement of the entire esophagus. Conservative treatment was the mainstay of management. In-hospital mortality was 13.5% (5/37).
CONCLUSIONS: DKA-associated AEN frequently presents with overt upper gastrointestinal bleeding, although bleeding may also develop after admission. Awareness of this condition may help clinicians consider timely diagnostic evaluation and supportive management in high-risk patients with DKA.
METHODS: A systematic literature search of PubMed and Web of Science was conducted from database inception to March 31, 2026, in accordance with PRISMA 2020. Eligible studies reported AEN confirmed by upper gastrointestinal endoscopy or postmortem examination occurring in association with DKA and provided sufficient case-level clinical data. Case reports and case series were included. Data were synthesized narratively.
RESULTS: Thirty-six studies involving 39 patients with DKA-associated AEN were included. The median age was 55.0 years (interquartile range [IQR], 49.0-65.0), and 29 patients (74.4%) were male. Overt upper gastrointestinal bleeding was reported in 28 of 32 evaluable cases (87.5%), although 10 patients (25.6%) developed bleeding only after admission. Shock or hypotension was present in 18 of 34 cases (52.9%). Endoscopy was performed in 34 cases (87.2%). AEN extent was evaluable in all 39 cases based on endoscopic or postmortem descriptions; 25 patients (64.1%) had mid/distal-predominant involvement, whereas 14 patients (35.9%) had involvement of the entire esophagus. Conservative treatment was the mainstay of management. In-hospital mortality was 13.5% (5/37).
CONCLUSIONS: DKA-associated AEN frequently presents with overt upper gastrointestinal bleeding, although bleeding may also develop after admission. Awareness of this condition may help clinicians consider timely diagnostic evaluation and supportive management in high-risk patients with DKA.