Esophagitis Dissecans Superficialis in a Patient With Prior Subtotal Gastrectomy and Roux-en-Y Reconstruction: A Case Report.

Esophagitis dissecans superficialis (EDS), also known as sloughing esophagitis, is a rare, benign disorder characterized by superficial sloughing of the esophageal mucosa. Its pathogenesis remains incompletely understood, with several underlying conditions and medication exposures described as potential predisposing factors. We present the case of a 41-year-old woman with an extensive surgical history, including subtotal gastrectomy with Roux-en-Y reconstruction, who presented with chronic upper abdominal pain and bloating. Esophagogastroduodenoscopy demonstrated superficial sloughing of the esophageal mucosa consistent with EDS. Subsequent histopathologic examination confirmed the diagnosis and showed no evidence of fungal infection. Because esophageal candidiasis was initially suspected based on the endoscopic appearance, the patient was empirically treated with fluconazole and continued proton pump inhibitor therapy. Repeat endoscopy six months later demonstrated complete resolution of the esophageal abnormalities. This case highlights EDS in a patient with extensively altered foregut anatomy and illustrates its potential to mimic infectious esophagitis. Although a causal relationship between prior gastric reconstruction and EDS cannot be established, recognizing this entity and correlating endoscopic and histopathologic findings are important for accurate diagnosis.