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Frieling T, Kreysel C, Blank M, Mülle D, Euler P, Melchior I. Not always eosinophilic esophagitis – intramural pseudodiverticulosis of the esophagus – a case report and literature review. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:1201-1207. [DOI: 10.1055/a-1288-1521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Background Intramural pseudodiverticulosis of the esophagus (EIPD) is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult, and the disease can be confounded with eosinophilic esophagitis (EoE). We present a patient with esophageal intramural pseudodiverticulosis and a literature review.
Case report The 45-year-old white caucasian woman with a history of nicotine and alcohol abuse had progressive hoarseness and severe dysphagia for solid food. Esophagogastroduodenoscopy (EGD) showed proximal esophageal stenosis, thrush esophagitis, and mucosal alteration with trachealization suspicious of EoE. However, repeated bouginage EGD and barium swallow revealed typical signs of esophageal intramural pseudodiverticulosis (EIPD). The patient was treated successfully by bougingage, acid suppression, and antifungal therapy. The literature analysis revealed the characteristics of EIPD according to age, sex, risk factors, and therapy modalities.
Conclusion The case report and the literature overview suggest that EIPD can be confounded with EoE.
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Affiliation(s)
- Thomas Frieling
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Christian Kreysel
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Michael Blank
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Dorothee Mülle
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Philipp Euler
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Ilka Melchior
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
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Abstract
Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.
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Siba Y, Gorantla S, Gupta A, Lung E, Culpepper-Morgan J. Esophageal intramural pseudodiverticulosis, a rare cause of food impaction: case report and review of the literature. Gastroenterol Rep (Oxf) 2014; 3:175-8. [PMID: 24951515 PMCID: PMC4423453 DOI: 10.1093/gastro/gou035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/06/2014] [Indexed: 12/22/2022] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a rare, benign condition of uncertain etiology and pathogenesis, which usually presents with either progressive or intermittent dysphagia. Acute presentation with food impaction, requiring emergency esophago-gastroduodenoscopy (EGD), is rare. We report a case of EIPD presenting as food bolus impaction in an elderly black female. The patient had no previous history of dysphagia or odynophagia. Currently accepted risk factors, such as diabetes mellitus, chronic alcoholism, and reflux esophagitis, were not present in our patient. Emergency EGD established the diagnosis and also dislodged the food bolus. Histopathological evaluation of the mucosa diagnosed co-existent acute candidal infection. Medical treatment with proton pump inhibitor and azole antifungal led to resolution of her symptoms. Review of the literature revealed that stenosis, strictures, perforation, gastro-intestinal bleed, and fistula formation are potential complications of EIPD. Multiple motility abnormalities have been described but are not consistent. Treatment of the underlying inflammatory and or infectious condition is the mainstay of management of this unusual condition.
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Affiliation(s)
- Yahuza Siba
- Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA and Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA
| | - Saritha Gorantla
- Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA and Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA
| | - Anand Gupta
- Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA and Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA
| | - Edward Lung
- Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA and Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA
| | - Joan Culpepper-Morgan
- Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA and Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA
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Rastogi A, Sarda D, Kothari P, Kulkarni B. Mediastinal tuberculosis presenting as traction diverticulum of the esophagus. Ann Thorac Med 2010; 2:126-7. [PMID: 19727361 PMCID: PMC2732090 DOI: 10.4103/1817-1737.33703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Accepted: 11/21/2006] [Indexed: 11/27/2022] Open
Abstract
A 7-year-old male presented with history of low-grade fever, epigastric pain and dysphagia. Ultrasound of abdomen and thorax revealed presence of paraesophageal lymphadenopathy. ‘Barium swallow’ and computerized tomography scan thorax with oral contrast suggested a provisional diagnosis of paraesophageal diverticulum. Esophagoscopy was normal. Endoscopic ultrasonography with biopsy confirmed tuberculosis. The patient was started on four-drug antitubercular treatment.
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Affiliation(s)
- Anurag Rastogi
- Department of Paediatric Surgery, L.T.M.M.C. and Gen. Hospital, Mumbai, India
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Abstract
BACKGROUND Esophageal tuberculosis is rare. Clinical and endoscopic features are variable, diverse, nonspecific, and poorly described. These findings may be confused with those of esophageal cancer and deep fungal infection. METHODS Medical records from a 5-year period (January 1997 to December 2001) were searched for cases of esophageal tuberculosis. For identified cases, the clinical, radiologic, and endoscopic features were evaluated. OBSERVATIONS Four cases of esophageal tuberculosis were encountered during the 5-year period studied. Three of the patients presented with dysphagia and weight loss. One patient had aspiration pneumonia and another fatal hematemesis. Endoscopic features included deep and large proximal esophageal ulcers in 2 patients, tracheo-esophageal fistula in one, and nonhealing proximal esophageal ulcer in another patient. CONCLUSION The present case series indicates that certain endoscopic features, such as deep and large esophageal ulcers, tracheoesophageal fistula, and nonhealing ulcer, are strongly suggestive of tuberculosis-related esophageal lesions.
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Affiliation(s)
- Shahab Abid
- Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Affiliation(s)
- C E Devereaux
- Departments of Medicine, Divisions of Gastroenterology, Naval Medical Center, San Diego and University of California, San Diego 92134-1005, USA
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