Supplementary Material for: Markers of Prognosis for Acute Esophageal Necrosis: A Systematic Review

Introduction: Acute esophageal necrosis (AEN) is a rare and lethal condition that may progress to sepsis and perforations. Most related literature comes from case reports; however, a few small reviews have been published. We conducted a large systematic review of AEN using PubMed, MEDLINE, and Embase to organize data into one consolidated manuscript, find potential prognosticators of illness, and determine possible treatment guidelines for AEN.
Methods: Advanced searches were performed of all English case reports from 1990 to 2021 using medical subject heading (MeSH) terms. Data on patient age, sex, comorbidities, initial presentation, management, progression of illness, and hospital survival were collected.
Results: Our study included 226 articles, encompassing 319 cases. 32.3% of patients had diabetes, 26.6% had hypertension, and 19.7% had alcohol use disorder. 66.5% presented with an upper gastrointestinal bleed and 21.9% developed sepsis or esophageal perforation. 60.9% of patients were reported to have survived their illness, but 16.6% of cases did not have their discharge status documented. Interestingly, patients presenting with pain or ketoacidosis demonstrated improved survival.
Conclusion: AEN becomes more prevalent as patients age and develop cardiovascular disease, which increases the risk of developing a hypoperfusive state and mucosal injury to the distal esophagus. Early fluid resuscitation, acid-reducing agents, and bowel rest may serve as potential lifesaving interventions, and antibiotics should be considered if there is concern for infection. Patients require close follow up in anticipation of impending stricture.

引言：急性食管坏死（Acute esophageal necrosis, AEN）是一种罕见且致命的疾病，可进展为脓毒症及食管穿孔。目前相关研究文献多以个案报告为主，仅少量小型综述发表。本研究借助PubMed、MEDLINE及Embase数据库开展了一项大规模系统综述，旨在整合相关数据形成统一文稿，挖掘该疾病潜在的预后因素，并确立AEN可行的治疗指南。
方法：本研究以医学主题词（Medical Subject Headings, MeSH）为检索策略，对1990年至2021年间发表的所有英文个案报告进行高级检索。最终收集了患者年龄、性别、合并症、初始临床表现、治疗方案、疾病进展情况及住院生存率相关数据。
结果：本研究共纳入226篇文献，涵盖319例AEN患者。其中32.3%的患者合并糖尿病，26.6%合并高血压，19.7%存在酒精使用障碍。66.5%的患者以上消化道出血为首发表现，21.9%的患者进展为脓毒症或食管穿孔。据报道，60.9%的患者存活出院，但16.6%的病例未记录出院转归情况。值得注意的是，以疼痛或酮症酸中毒为首发表现的患者生存率更高。
结论：随着患者年龄增长及合并心血管疾病，急性食管坏死的患病率逐渐升高，此类患者更易出现低灌注状态及远端食管黏膜损伤。早期液体复苏、抑酸治疗及肠道休息可能是潜在的救命干预措施，若怀疑合并感染则应考虑使用抗生素。患者需接受密切随访，以及时发现即将发生的食管狭窄。