{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:12:51Z","timestamp":1789560771169,"version":"build-2803163510"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 2","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Esophagitis dissecans superficialis (EDS), also referred to as \u201csloughing esophagitis,\u201d is an uncommon benign condition characterized by the desquamation of the superficial layer of the esophageal squamous mucosa. It is often underdiagnosed due to its rarity and nonspecific clinical presentation. Although several factors such as caustic ingestion, thermal injury, autoimmune disorders, and mechanical trauma have been implicated, medication-induced mucosal injury remains one of the most significant causes. Among these, bisphosphonates \u2013 a class of drugs widely prescribed for osteoporosis and other bone-related disorders \u2013 have been identified as a potential offending agent. We report the case of a 66-year-old woman with no significant comorbidities who presented with persistent retrosternal burning and pain for 2 months. There was no associated dysphagia, odynophagia, vomiting, hematemesis, weight loss, or history of nonsteroidal anti-inflammatory drug use. Physical and systemic examinations were unremarkable. Despite treatment with double-dose esomeprazole for 8 weeks, her symptoms persisted. Upper gastrointestinal endoscopy revealed a large area of whitish sloughed-off mucosa overlying a superficial ulcer with regular margins, extending from 26 cm to just above the gastroesophageal junction. A detailed drug history subsequently revealed the use of bisphosphonate gel for osteoporosis. Histopathological analysis demonstrated sloughed squamous epithelium with the features of superficial mucosal necrosis, confirming the diagnosis of EDS secondary to bisphosphonate-induced chemical injury. Discontinuation of the bisphosphonate and continuation of proton-pump inhibitor therapy led to complete symptom resolution within 2 weeks. This case underscores the importance of considering drug-induced esophageal injury in patients with refractory retrosternal pain unresponsive to acid suppression therapy. Bisphosphonates, although highly effective in osteoporosis management, may cause significant mucosal damage when not used properly. Clinicians should maintain a high index of suspicion for bisphosphonate-induced EDS, as timely recognition and withdrawal of the offending agent usually result in rapid clinical and endoscopic improvement.<\/jats:p>","DOI":"10.4103\/aam.aam_837_25","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T06:00:09Z","timestamp":1776924009000},"page":"S375-S379","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Bisphosphonate-induced Esophagitis Dissecans Superficialis: A Rare Case Report"],"prefix":"10.4103","volume":"25","author":[{"given":"Yogesh","family":"Bade","sequence":"first","affiliation":[{"name":"Department of Medical Gastroenterology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junaid","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medical Gastroenterology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Bharti","sequence":"additional","affiliation":[{"name":"Department of Medical Gastroenterology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"R1-20260916","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1097\/PAS.0b013e3181b7ce21","article-title":"Esophagitis dissecans superficialis (\"sloughing esophagitis\"): A clinicopathologic study of 12 cases","volume":"33","author":"Carmack","year":"2009","journal-title":"Am J Surg Pathol"},{"key":"R2-20260916","first-page":"178","article-title":"Sloughing esophagitis: A spectacular histologic and endoscopic disease without a uniform clinical correlation","author":"Moawad","journal-title":"Ann N Y Acad Sci 2016"},{"key":"R3-20260916","doi-asserted-by":"crossref","first-page":"p. 728","DOI":"10.1002\/9781119599692.ch42","article-title":"Medication\u2010Induced Esophageal Injury","author":"Katzka","year":"2021","journal-title":"Esophagus"},{"issue":"Suppl 4","key":"R4-20260916","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1634\/theoncologist.9-90004-3","article-title":"Bisphosphonates: Preclinical review","volume":"9","author":"Green","year":"2004","journal-title":"Oncologist"},{"key":"R5-20260916","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1023\/A:1016495221567","article-title":"What the gastroenterologist should know about the gastrointestinal safety profiles of bisphosphonates","volume":"47","author":"Graham","year":"2002","journal-title":"Dig Dis Sci"},{"key":"R6-20260916","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s10620-015-3590-3","article-title":"Esophagitis dissecans superficialis: clinical, endoscopic, and histologic features","volume":"60","author":"Hart","year":"2015","journal-title":"Dig Dis Sci"},{"key":"R7-20260916","first-page":"371","article-title":"Esophagitis dissecans superficialis: A case series of 7 patients and review of the literature","volume":"80","author":"Fiani","year":"2017","journal-title":"Acta Gastroenterol Belg"},{"key":"R8-20260916","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s11938-022-00399-6","article-title":"Esophageal Manifestations of Dermatological Diseases, Diagnosis, and Management","volume":"20","author":"Arar","year":"2022","journal-title":"Curr Treat Options Gastroenterol"},{"key":"R9-20260916","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1111\/j.1442-2050.2009.00972.x","article-title":"Drug-induced esophagitis","volume":"22","author":"Zografos","year":"2009","journal-title":"Dis Esophagus"},{"key":"R10-20260916","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1038\/modpathol.2011.204","article-title":"Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa","volume":"25","author":"Purdy","year":"2012","journal-title":"Mod Pathol"},{"key":"R11-20260916","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1097\/MPG.0000000000003154","article-title":"Esophagitis dissecans superficialis in children","volume":"73","author":"Ebigbo","year":"2021","journal-title":"J Pediatr Gastroenterol Nutr"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_837_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:00:44Z","timestamp":1789560044000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_837_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":11,"journal-issue":{"issue":"Suppl 2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_837_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]},"assertion":[{"value":"2025-12-18","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}