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Microscopic Features

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Biopsies show a two‐toned appearance, with a superficial zone of necrotic, eosinophilic squamous epithelium and underlying intact squamous mucosa that appears normal or reactive. The necrotic epithelial layer may be partially or completely detached and exhibits pyknotic, parakeratosis‐like or faded, ghost‐like nuclei. In some cases a neutrophilic infiltrate is seen between the epithelial layers, ranging from mild to severe (Figure 2.18). In black esophagus, biopsies show necrotic squamous epithelium and mucosa, with possible involvement of submucosa. Pill fragments and surface colonization by bacteria or fungal yeasts have also been described.

Gastrointestinal Pathology

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