Citation: BMJ Open Gastroenterology. 7(1), 2020 Aug..Journal: BMJ open gastroenterology.Published: ; 2020ISSN: 2054-4774.Full author list: Siddiqi A; Chaudhary FS; Naqvi HA; Saleh N; Farooqi R; Yousaf MN.UI/PMID: 32788199.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Health Baltimore Residents | MedStar Union Memorial HospitalDepartment(s): MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: https://dx.doi.org/10.1136/bmjgast-2020-000466 (Click here)Abbreviated citation: BMJ Open Gastroenterol. 7(1), 2020 Aug.Abstract: Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival. Copyright (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.