Thermal injury of the human esophageal mucosa secondary to ingestion of hot beverages-A distinct endoscopic entity

Background: Thermal injury of the esophageal mucosa is rarely reported in the medical literature. We recently encountered two patients who presented with atypical chest pain and mild upper gastrointestinal tract bleeding. An upper endoscopy led to the detection of characteristic mucosal appearance and distinctive histological abnormalities. Methods: Each patient underwent initial and follow-up upper endoscopies along with multiple mucosal biopsies. All upper endoscopies were performed in a routine manner. Mucosal biopsies from the esophagus were obtained in formalin, and stained with hematoxylin and eosin. The histology of the mucosal biopsies was examined and interpreted by the pathologist. Results: Bands of thin, white pseudomembranous mucosa alternating with pink intervening mucosal stripes were observed in the esophagus in both cases (See Figure below). Histopathological examination of the esophageal mucosa revealed superficial mummified layer of nonviable anucleated squamous epithelium adherent to underlying viable epithelium and mucosa. Biopsies were negative for Candida albicans, Cytomegalovirus or Herpes simplex viral inclusion bodies, gastroesophageal reflux or Barrett's epithelium. On close interrogation, both patients admitted to drinking piping hot beverages and soups. Discontinuation of this practice was associated with a complete resolution of symptoms and normalization of esophageal mucosa documented by serial esophagoscopies and biopsies. Conclusion: These observations suggest that ingestion of hot beverages can result in distinctive, although reversible injury to the esophageal mucosa. (Figure presented).