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Shintaku M. Esophageal intramural pseudodiverticulosis. World J Gastroenterol 2024; 30:137-145. [PMID: 38312118 PMCID: PMC10835521 DOI: 10.3748/wjg.v30.i2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a disease of unknown pathogenesis characterized by usually systemic, cystic dilatation of the excretory ducts of esophageal submucosal glands. In this article, I review the epidemiology, clinical manifestations, endoscopic findings, esophagographic findings, and histopathology of EIPD. I also discuss the etiology and possible pathogenesis of EIPD based on my experiences with this disease and a review of the literature. EIPD usually presents with dysphagia in middle-aged individuals. It is often complicated with secondary infections, most commonly candidiasis. On esophagography, EIPD is delineated as small, multiple, flask-shaped outward projections within the esophageal wall. In recent years, EIPD has been mainly diagnosed by endoscopic findings of multiple, localized, small mucosal depressions. The orifices of the "pseudodiverticula" periodically open and close, and excrete mucus onto the mucosal surface. On histopathological examination, the luminal surface of dilated ducts in EIPD is covered by multilayered, hyperplastic epithelial cells, but myoepithelial cells in the glandular acini are well preserved. Treatment of EIPD is usually symptomatic therapy, and prevention of the infectious complications is important. The etiology and pathogenesis of EIPD are largely unknown, but functional abnormalities of autonomic nerve fibers innervating the esophageal glands likely play an important role, since the structures of the glands are basically preserved in this disease.
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Affiliation(s)
- Masako Shintaku
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Hirakata 573-8511, Osaka, Japan
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Veria S, Glosser LD, Lombardi CV, Javaid T, Ramadugu A. Symptomatic esophageal intramural pseudodiverticulosis without stricture: A case report. SAGE Open Med Case Rep 2023; 11:2050313X221140244. [PMID: 36814679 PMCID: PMC9940231 DOI: 10.1177/2050313x221140244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 11/03/2022] [Indexed: 02/19/2023] Open
Abstract
Esophageal intramural pseudodiverticulosis is a benign disease characterized by numerous, small outpouchings from the esophageal epithelium. Esophageal intramural pseudodiverticulosis has scarcely been reported with only 200-300 cases worldwide. The etiology of esophageal intramural pseudodiverticulosis is also unclear; however, there is an associated increased risk with diabetes mellitus, gastroesophageal reflux disease, esophageal candidiasis, and chronic alcohol and tobacco abuse. Esophageal intramural pseudodiverticulosis has a characteristic appearance on esophagogastroduodenoscopy. Treatment of esophageal intramural pseudodiverticulosis has historically been limited to symptom management with acid suppression, anti-fungal therapy, and endoscopic dilation in areas of stricture. This report is a case of a 52-year-old female status post two esophageal stricture repairs with dilation over prior 2 years, who presented with non-remitting solid food dysphagia and food impaction found to have esophageal intramural pseudodiverticulosis with concomitant jackhammer esophagus and esophageal candidiasis.
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Affiliation(s)
- Spiro Veria
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Logan D Glosser
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Conner V Lombardi
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
- Conner V Lombardi, College of Medicine and Life Sciences, The University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA.
| | - Toseef Javaid
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, USA
| | - Ajit Ramadugu
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, USA
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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. Z Gastroenterol 2020; 58:1201-1207. [DOI: 10.1055/a-1288-1521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Liu XY, Jiao CH, Zhao D, Chen Y, Zhang HM. Psychological impact of high-quality nursing care on patients with esophageal cancer during perioperative period: A protocol of systematic review. Medicine (Baltimore) 2020; 99:e22270. [PMID: 33120731 PMCID: PMC7581172 DOI: 10.1097/md.0000000000022270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study is designed to systematically assess the psychological impact of high-quality nursing care (HQNC) on patients with esophageal cancer during perioperative period (ECPP). METHODS Several electronic databases will be searched to collect randomized controlled trials (RCTs) or case-control studies (CCSs) on HQNC in the management of ECPP from inception to present: Cochrane Library, PUBMED, EMBASE, SinoMed, Web of Science, WANGFANG, and China National Knowledge Infrastructure. We will not apply any language limitation to all literature searches. Two authors will independently perform literature selection, data extraction and literature quality evaluation. All disagreements will be resolved by a third author through discussion. Cochrane risk of bias tool will be employed to assess trial quality, and RevMan 5.3 software will be utilized to carry out statistical analysis. RESULTS This study will summarize the current evidence to appraise of the psychological impact of HQNC in the management of ECPP. CONCLUSION The findings of this study may help to explicit whether HQNC is effective on psychological problem in ECPP. It will also provide scientific evidence for the clinical practice and future researches. STUDY REGISTRATION INPLASY202080071.
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Affiliation(s)
| | - Chuan-hua Jiao
- Department of Dermatology, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Dan Zhao
- Department of Dermatology, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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Abstract
INTRODUCTION With 250 published cases worldwide, diffuse esophageal intramural pseudo-diverticulosis (DEIPD) is a poorly understood disease. The aim of this study was to determine the prevalence of DEIPD in our own population, identify risk factors and clinical symptoms, and characterize its typical endoscopic signs. METHODS Retrospective search in our center's endoscopic and clinical database. Reviewing of all cases by re-examining stored endoscopic photographs. Reviewing of all cases regarding age, sex, risk factors, comorbidities, histology, and clinical symptoms. RESULTS In a population of 150.000 we found 21 cases of DEIPD. Mean age was 56 ± 10 years. 86% were males, 76% had alcohol abuse, 57% had nicotine abuse, 38% had arteriosclerosis, 33% had COPD, 29% had malignancies, 24% had liver cirrhosis, 19% had impaired kidney function, and 15% had diabetes. Dysphagia was present in 62% and food bolus impaction (single or repeated) in 48%. Endoscopically, 95% of patients had multiple (> 4), small (0.25-2.5 mm) pseudodiverticle openings in the esophageal wall. In 62%, openings were aligned longitudinally. 86% showed edematous swelling of mucosa ("frosted glass look"), 76% showed a fine-grained pattern of small (10-100 µm) red dots ("faux uni pattern"), and 76% had a rigid, narrow lumen with multiple rings ("trachealization"). CONCLUSION With a prevalence of approximately 5 to 50/100.000, DEIPD may be more frequent than previously estimated. It preferably affects middle-aged male alcoholics. Key symptoms are chronic dysphagia and food impaction. Typical endoscopic findings are multiple, small, longitudinally aligned pseudodiverticle openings, frosted glass look, faux uni pattern, and trachealization of the esophagus.
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Affiliation(s)
- Florian Hentschel
- Center for Internal Medicine II, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
- Zentrum für Innere Medizin II, Hochschulklinikum Brandenburg der MHB, Hochstr. 29, 14770, Brandenburg an der Havel, Germany.
| | - Stefan Lüth
- Center for Internal Medicine II, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Aimi M, Mikami H, Izumi D, Okimoto E, Tada Y, Mishiro T, Ishimura N, Ishihara S, Kinoshita Y. Evaluation of esophageal intramural pseudo-diverticulosis using high-resolution manometry. Clin J Gastroenterol 2016; 9:281-4. [PMID: 27412025 DOI: 10.1007/s12328-016-0672-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/03/2016] [Indexed: 02/07/2023]
Abstract
Esophageal intramural pseudo-diverticulosis (EIPD) is a rare disease characterized by multiple small flask-shaped pouches in the esophageal wall, with the predominant symptom of chronic progressive or intermittent dysphagia. However, its etiology and pathogenesis remain unknown. We present a case of EIPD evaluated with high-resolution manometry in a 75-year-old man with food impaction after eating beef, who came to our emergency department. The patient experienced similar episodes three times previously, though the cause was unknown. Computed tomography (CT) findings revealed diffuse wall thickness in the upper intrathoracic esophagus, while esophagogastroduodenoscopy showed multiple small depressions and several white plaque patches, and a barium meal esophagogram showed characteristic multiple small outpouching areas. From these findings, we diagnosed the patient with EIPD. In addition, high-resolution manometry revealed strong contractions in the distal esophagus. We started an administration of isosorbide dinitrate, because abnormal esophageal motility may have been causative of the condition and development of pseudo-diverticulosis. Thereafter, the patient had a good clinical course without food impaction. Elevated intra-esophageal luminal pressure caused by abnormal esophageal motility seems to be an important factor in the pathogenesis of EIPD in some cases.
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Affiliation(s)
- Masahito Aimi
- Second Department of Internal Medicine, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.
| | - Hironobu Mikami
- Second Department of Internal Medicine, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Daisuke Izumi
- Second Department of Internal Medicine, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Eiko Okimoto
- Second Department of Internal Medicine, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Yasumasa Tada
- Department of Gastroenterology, Matsue Red Cross Hospital, 200 Horo-machi, Matsue-shi, Shimane, 690-8506, Japan
| | - Tsuyoshi Mishiro
- Second Department of Internal Medicine, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Norihisa Ishimura
- Second Department of Internal Medicine, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Shunji Ishihara
- Second Department of Internal Medicine, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Yoshikazu Kinoshita
- Second Department of Internal Medicine, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
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Wen Y, Hu X. Expression of esophageal carcinoma related gene 4 (ECRG4) and its clinical significance in prognosis of esophageal carcinoma. Int J Clin Exp Pathol 2015; 8:14772-14778. [PMID: 26823803 PMCID: PMC4713589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/21/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to analyze the relationship between the expression level of esophageal carcinoma related gene 4 (ECRG4) in esophageal cancer tissues and the occurrence of esophageal carcinoma. 50 cases of esophageal carcinoma tissues and adjacent tissues were collected as study samples. mRNA and protein expression levels of ECRG4 in tumor tissues and adjacent tissues were analyzed by real-time fluorescence quantitative PCR, Western blot and immunohistochemistry. The relationship between the expression level of ECRG4 and the clinical and pathological features and postoperative recurrence and survival was also analyzed. Real-time fluorescent quantitative PCR and Western blot showed that the mRNA and protein levels of ECRG4 in esophageal cancer tissues were significantly down regulated (P<0.04). There was ECRG low expression in 74 cases and high expression in 17 cases. The expression level of ECRG4 protein in esophageal carcinoma tissues was closely related to tumor invasion level, TNM staging and lymph node metastasis (P<0.05), but not related to gender, age, tumor type and differentiation degree of patients (P>0.05). The cumulative recurrence rate of patients of higher ECRG expression was significantly lower than that of patients of lower ECRG4 expression in 5 years after surgery, and the cumulative recurrence rate was 5 years (P<0.05). And the cumulative survival rate of patients with high ECRG4 expression was significantly higher than that of patients with low expression of ECRG4 in 5 years after surgery (P<0.05). In conclusion, the low expression or no expression of ECRG4 in esophageal cancer tissues was closely related to the degree of tumor invasion level, TNM staging, lymph node metastasis and recurrence and survival after surgery.
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Affiliation(s)
- Yiyang Wen
- Department of Oncology, Henan Provincial People’s Hospital (The People’s Hospital of Zhengzhou University)Zhengzhou 450000, China
| | - Xiaoshu Hu
- Department of Pathology, People’s Hospital of ZhengzhouZhengzhou 450000, China
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