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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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Kunimitsu A, Ujiie N, Sato C, Taniyama Y, Okamoto H, Fukutomi T, Ozawa Y, Ohnuma S, Unno M, Kamei T. Esophageal Intramural Pseudodiverticulosis Diagnosed by Combining Esophagogastroduodenoscopy, Esophagography, and High-resolution manometry: A Case Report. Intern Med 2022; 62:1495-1499. [PMID: 36223924 DOI: 10.2169/internalmedicine.0337-22] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a rare disease. A 78-year-old man with dysphagia presented to our hospital. The presence of diffuse esophageal spasm was suspected by his primary-care doctor. High-resolution manometry (HRM) showed no abnormal findings. The patient was diagnosed with EIPD and Candida esophagitis, by esophagogastroduodenoscopy (EGD) and esophagography. His symptoms improved after symptomatic treatment for Candida esophagitis with oral administration of an antifungal drug. EIPD should be considered in patients with dysphagia; EGD and esophagography should be performed when diagnosing EIPD.
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Affiliation(s)
- Atsushi Kunimitsu
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Naoto Ujiie
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Chiaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yusuke Taniyama
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Hiroshi Okamoto
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Toshiaki Fukutomi
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yohei Ozawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Shinobu Ohnuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
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Ali O, Asumu H, Kaur T, Mathew A, Kim R. A rare cause of dysphagia due to esophageal intramural pseudodiverticulosis: a case report and review of literature. BMC Gastroenterol 2020; 20:72. [PMID: 32178627 PMCID: PMC7074979 DOI: 10.1186/s12876-020-01209-y] [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] [Received: 08/08/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Esophageal intramural pseudodiverticulosis is an uncommon, idiopathic disorder characterized by multiple small outpouchings protruding from the esophageal lumen. Esophageal intramural pseudodiverticulosis is associated with conditions such as gastroesophageal reflux disease and diabetes mellitus, as well as emergent complications including pneumomediastinum. The most common presenting symptom is dysphagia with associated esophageal stricture formation. While the pathogenesis of EIP has yet to be determined, it is important to bring awareness to this unique disease with distinctive diagnostic findings and treatment options. CASE PRESENTATION In this case, we present a 62-year-old woman who suffered from dysphagia, an inability to tolerate a regular diet, and unintentional weight loss for several years prior to her diagnoses. She was diagnosed by esophagram and esophagogastroduodenoscopy to have esophageal intramural pseudodiverticulosis, complicated by severe stricture formation. Following treatment with sequential dilatation and maintenance H2-blocker therapy, she achieved significant symptomatic improvement. CONCLUSIONS This case highlights the importance of accurate identification and treatment of an uncommon cause of dysphagia, esophageal intramural pseudodiverticulosis. Treatment includes dilatational therapy, as successfully demonstrated in our patient. Furthermore, treatment is focused on optimizing medical management, as demonstrated in our patient with the addition of an H2-blocker for GERD, or addressing potentially serious underlying causes, such as carcinoma, with surgery.
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Affiliation(s)
- Osman Ali
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Hazel Asumu
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Tanisha Kaur
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Angelina Mathew
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Raymond Kim
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA.
- Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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Takeshita N, Kanda N, Fukunaga T, Kimura M, Sugamoto Y, Tasaki K, Uesato M, Sazuka T, Maruyama T, Aida N, Tamachi T, Hosokawa T, Asai Y, Matsubara H. Esophageal intramural pseudodiverticulosis of the residual esophagus after esophagectomy for esophageal cancer. World J Gastroenterol 2015; 21:9223-9227. [PMID: 26290650 PMCID: PMC4533055 DOI: 10.3748/wjg.v21.i30.9223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/07/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer (T3N2M0 Stage III) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation, including redness, erosion, edema, bleeding, friability, and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine, gastrografin-filled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly, endoscopic balloon dilatation was performed and anti-fungal therapy was started in the hospital. Seven weeks later, endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently, the patient was discharged. At the latest follow-up, the patient was symptom-free and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.
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MESH Headings
- Aged, 80 and over
- Antifungal Agents/therapeutic use
- Biopsy
- Candida glabrata/isolation & purification
- Candidiasis/microbiology
- Deglutition Disorders/etiology
- Dilatation
- Diverticulosis, Esophageal/diagnosis
- Diverticulosis, Esophageal/etiology
- Diverticulosis, Esophageal/microbiology
- Diverticulosis, Esophageal/therapy
- Diverticulum, Esophageal/diagnosis
- Diverticulum, Esophageal/etiology
- Diverticulum, Esophageal/microbiology
- Diverticulum, Esophageal/therapy
- Esophageal Neoplasms/pathology
- Esophageal Neoplasms/surgery
- Esophageal Stenosis/etiology
- Esophagectomy/adverse effects
- Esophagoscopy
- Humans
- Male
- Neoplasm Staging
- Risk Factors
- Tomography, X-Ray Computed
- Treatment Outcome
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Chiba T, Iijima K, Koike T, Uno K, Asano N, Shimosegawa T. A case of severe esophageal intramural pseudodiverticulosis whose symptoms were ameliorated by oral administration of anti-fungal medicine. Case Rep Gastroenterol 2012; 6:103-10. [PMID: 22619654 PMCID: PMC3355650 DOI: 10.1159/000336846] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a rare disease of unknown etiology that displays multiple pseudodiverticula radiologically, leading to benign esophageal stricture. Dysphagia, which sometimes slowly progresses, is the main symptom in the majority of cases. We here report a 59-year-old male EIPD patient who suffered from severe dysphagia. Radiography and endoscopy of this patient disclosed a severe constriction in the upper thoracic esophagus. Although we tried several endoscopic procedures including frequent endoscopic balloon dilatation (EBD), the effect was very limited and his dysphagia relapsed shortly after the treatments. During the procedures, we noticed some white, thick, creamy liquid emerging from the orifices of EIPD, and PAS staining of biopsy specimens revealed infection with Candida albicans. Hence, the patient was given anti-fungal medicine in addition to EBD. The additional treatment with anti-fungal medicine dramatically improved his symptoms and the esophageal constriction. This case suggests that anti-fungal treatment is an effective first-line therapy even against a severe form of esophageal constriction in EIPD.
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Affiliation(s)
- Takashi Chiba
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
Esophageal intramural pseudodiverticulosis (EIP) is a rare benign disease that is characterized by multiple tiny flask-shaped outpouching lesions of the esophageal wall. The etiology is unknown, but the pathologic findings include dilatation of excretory ducts of submucosal glands. The predominant symptom is dysphagia, and esophageal stricture occurs frequently. Diseases such as diabetes mellitus, esophageal candidiasis, gastroesophageal reflux disease, and chronic alcoholism are often combined. Since most EIP cases are benign, the mainstream treatment is symptom relief by endoscopic dilatation or medical treatment of accompanied diseases. This report describes the case of a 68-year-old male patient who suffered from chest tightness for 2 months and was diagnosed with EIP. This symptom disappeared after 2 months of medical treatment, and the patient is now being regularly followed up.
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Affiliation(s)
- Young Eun Chon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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