Variable topography of black oesophagus (acute necrotising oesophagitis)

Black oesophagus, or acute necrotising oesophagitis, is characterised by diffuse circumferential black discolouration of the distal oesophagus associated with mucosal necrosis. A consistent feature is a very sharp line of demarcation at the gastro-oesophageal junction. Two cases are reported to demonstrate differences in the lower margin. Case 1: a 63-year-old man who died of gastrointestinal haemorrhage complicating black oesophagus was noted to have an irregular lower border located approximately 5 cm from the gastro-oesophageal junction. This was associated with columnar mucosa typical of Barrett oesophagus. Case 2: a 79-year-old man who aspirated gastric contents following gastrointestinal haemorrhage due to black oesophagus had diffuse black discolouration of the oesophageal mucosa with the more usual sharply demarcated inferior margin at the gastro-oesophageal junction. Sparing of the distal oesophagus in case 1 was most likely due to the protective effect of metaplastic columnar epithelium, a finding that may, therefore, be a potential macroscopic marker for Barrett oesophagus in individuals with black oesophagus.