Balakrishnan Arivalagan, MD1, Rayan Alataa, MD2, Fnu Veena, MD3, Haider Ghazanfar, MD2, Sahil Dudhat, MD2, RahulReddy Nallapareddy, MD2 1BronxCare Health System, New York, NY; 2BRONX CARE HEALTH SYSTEM, Bronx, NY; 3BronxCare Health System, Bronx, NY Introduction: Traditionally, herbal medicines are used to treat diseases or maintain health, often considered safe. Corrosive injuries caused by this alternative medicine ingestion are an emerging health concern and reported scarce. We present a case of severe corrosive necrosis of esophagus and stomach in an elderly male following herbal medicine consumption.
Case Description/
Methods: A male in seventies with a history of chronic headache was brought to our emergency room with three-day history of low-grade fever, abdominal discomfort, and odynophagia. His physical examination and lab tests were unremarkable. Contrast-enhanced computed tomography (CECT) demonstrated non-visualization of the esophagus suggestive of an esophageal mass. The patient’s family reported patient’s recent use of herbal products for headaches. Based on the history suspected chemical injury and an urgent EGD revealed extensive necrosis of the esophagus, stomach, and duodenum with darkish grey fluid in the gastric lumen as shown in the figures. The patient received N-acetylcysteine (NAC) infusion, micronutrient supplementation, total parenteral nutrition, and feeding jejunostomy during his hospital course. Despite supportive care, he developed esophageal strictures and underwent multiple sessions of endoscopic dilation. Discussion: Corrosive ingestion due to alternative medicine could result in catastrophic outcomes. Esophagoduodenoscopy remains a crucial tool in the early assessment and prognostication of mucosal injury. Zangar classification is widely used endoscopic grading system and grades 2B-4 has worse prognosis (1). Early administration of NAC with vitamin B complex shown faster recovery and reduced long-term complications (2). A thorough history, timely endoscopic evaluation, and early intervention are pivotal in optimizing patient outcomes. This case highlights the occurrence of corrosive injuries due to herbal medicine, the need for heightened awareness among clinicians and establishment of standardized protocols in managing the serious complications of herbal remedies. References 1. Gurvits GE. Black esophagus: acute esophageal necrosis syndrome. World J Gastroenterol. 2010 Jul 14;16(26):3219-25. 2. El-Sobky H, El-Shanawany SM, Ghanem M, Atef M. Role of N-acetylcysteine and vitamin B complex in improving outcomes of corrosive ingestion. Toxicol Res (Camb). 2024 Jan 4;13(1).
Figure: Endoscopic images: Figure A-F Figure A &B - Extensive necrosis of the esophageal mucosa - Zargar Class III B corrosive injury Figure C& D: Focal areas of necrosis and deep ulcers seen in the stomach Figure E: Erythematous, edematous mucosa with focal areas of necrosis in the first part of the duodenum Figure F: Erythematous, edematous mucosa with superficial ulcerations in the second part of the duodenum
Disclosures: Balakrishnan Arivalagan indicated no relevant financial relationships. Rayan Alataa indicated no relevant financial relationships. Fnu Veena indicated no relevant financial relationships. Haider Ghazanfar indicated no relevant financial relationships. Sahil Dudhat indicated no relevant financial relationships. RahulReddy Nallapareddy indicated no relevant financial relationships.
Balakrishnan Arivalagan, MD1, Rayan Alataa, MD2, Fnu Veena, MD3, Haider Ghazanfar, MD2, Sahil Dudhat, MD2, RahulReddy Nallapareddy, MD2. P5157 - Extensive Corrosive Necrosis of Gastrointestinal Tract Following Herbal Therapy, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
